Vluggen Thom Pauline Maria Johannes, van Vugt Raoul, Boonen Bert, Keulen Mark Hendrik Franciscus
The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands.
BMJ Case Rep. 2021 May 31;14(5):e240684. doi: 10.1136/bcr-2020-240684.
We present the case of an 82-year-old female, who experienced a ground-level fall on the trochanter of the right femur. X-rays showed a proximal femoral fracture (PFF) with an unclear and unusual fracture pattern. Three-dimensional CT images were obtained and showed a displaced femoral neck fracture and ipsilateral fracture of the greater trochanter. Our patient underwent unipolar hemiarthroplasty and fixation of the greater trochanter with a hook plate and cable grip. At 11 months, functional outcomes, patient satisfaction and quality of life were excellent. Primary osteoporosis was diagnosed and treatment with bisphosphonates was initiated.Two-level PFFs are rare and complex. Due to ageing and a subsequent increase in osteoporosis, numbers of PFFs with complex fracture patterns might increase in the future. Adequate treatment and early prevention of osteoporosis are key to reduce this risk and lower the overall burden. Surgical treatment should be patient-tailored and focus on minimising the risk of complications and reinterventions.
我们报告了一例82岁女性患者，她在平地摔倒，右股骨转子着地。X线显示近端股骨骨折（PFF），骨折模式不明确且不寻常。获取了三维CT图像，显示股骨颈移位骨折和同侧大转子骨折。我们的患者接受了单极半髋关节置换术，并使用钩板和缆索固定器固定大转子。11个月时，功能结果、患者满意度和生活质量都非常好。诊断为原发性骨质疏松症，并开始使用双膦酸盐进行治疗。两级PFF很少见且复杂。由于老龄化以及随后骨质疏松症的增加，未来具有复杂骨折模式的PFF数量可能会增加。充分治疗和早期预防骨质疏松症是降低这种风险和减轻总体负担的关键。手术治疗应根据患者情况量身定制，重点是将并发症和再次干预的风险降至最低。
