Den Haese Jason P, Delgadillo Blake E, Anderson Bryan G, Storm Shawn W
Department of Orthopedic Surgery, Lake Erie College of Osteopathic Medicine (LECOM) Health, Millcreek Community Hospital, Erie, USA.
Department of Orthopedic Surgery, Lake Erie College of Osteopathic Medicine (LECOM), Bradenton, USA.
Cureus. 2022 Dec 30;14(12):e33150. doi: 10.7759/cureus.33150. eCollection 2022 Dec.
Peri-trochanteric fractures with an extension into the femoral neck are relatively rare. Due to the lack of a defined treatment in the literature, these fractures pose a challenge to orthopedic surgeons. This case report highlights the value of timing to surgical intervention, choosing the appropriate operative course, not treating very important person (VIP) patients differently than standard patients, and decreasing unnecessary costs for the patient and the US healthcare system. An 85-year-old male VIP patient presented to the emergency department (ED) with a left peri-trochanteric fracture with an extension into the ipsilateral femoral neck. The initial plan was to perform arthroplasty with diaphyseal fixation. However, the community-based hospital would have to wait two to three days for the proper implants, and the patient insisted on being treated at this hospital. Due to concerns about increased mortality with delayed treatment, the patient underwent short cephalomedullary nail (CMN) fixation the next day. On postoperative day (POD) 49, a was heard and felt while ambulating, and radiographs revealed substantial lateral cutout of the CMN and subsidence of the femoral head. On POD 54, the patient underwent a successful left total hip arthroplasty using a modular diaphyseal press-fit femoral component, which resulted in an uneventful recovery. This case illustrates a cautionary tale in choosing the appropriate operative course for a VIP patient with a peri-trochanteric fracture extending into the femoral neck (a relatively rare fracture type that has no clearly defined treatment option). This is imperative to reduce pain and length of stay for the patient, postoperative complications, and cost. Based on the results from the second procedure and weighing the risk of prolonged treatment, the authors believe that this patient would likely have benefited from a primary arthroplasty procedure given his body habitus and complex fracture pattern.
延伸至股骨颈的转子周围骨折相对少见。由于文献中缺乏明确的治疗方法，这些骨折给骨科医生带来了挑战。本病例报告强调了手术干预时机的重要性、选择合适的手术方案、对贵宾（VIP）患者与普通患者一视同仁，以及降低患者和美国医疗系统不必要的费用。一名85岁的男性VIP患者因左转子周围骨折并延伸至同侧股骨颈而被送往急诊科。最初的计划是进行带骨干固定的关节置换术。然而，这家社区医院必须等待两到三天才能获得合适的植入物，而患者坚持在这家医院接受治疗。由于担心延迟治疗会增加死亡率，患者第二天接受了短头髓内钉（CMN）固定。术后第49天，患者在行走时听到并感觉到异常，X线片显示CMN有明显的外侧穿出和股骨头下沉。术后第54天，患者使用模块化骨干压配型股骨组件成功进行了左全髋关节置换术，术后恢复顺利。本病例说明了为一名转子周围骨折延伸至股骨颈的VIP患者（一种相对罕见且治疗方案不明确的骨折类型）选择合适手术方案时的警示故事。这对于减轻患者的疼痛、缩短住院时间、减少术后并发症和降低费用至关重要。根据第二次手术的结果并权衡延长治疗的风险，作者认为鉴于该患者的身体状况和复杂的骨折模式，他可能从一期关节置换术中获益。
