Hidayat Adri Yandra, Rifardi Dhandia, Pribadi Bayu Pratama Putra
Department of Surgery, Division of Orthopaedic, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia; Division of Orthopaedic, Arifin Achmad Hospital, Pekanbaru, Indonesia.
Division of Orthopaedic, Arifin Achmad Hospital, Pekanbaru, Indonesia.
Int J Surg Case Rep. 2024 Mar;116:109367. doi: 10.1016/j.ijscr.2024.109367. Epub 2024 Feb 8.
Ipsilateral proximal, shaft, and distal femur fractures are extremely uncommon. It might be challenging and contentious to treat ipsilateral multi-level femur fractures. There are still unanswered questions regarding the order of fracture types that should be repaired first and the type of implant that should be used.
A twenty-nine-year-old male patient was assessed at the emergency department after a motorcycle accident. The patient had a clearly deformed left lower extremity and was complaining of pain in the left thigh. Preoperative radiographs revealed ipsilateral multi-level femur fracture on the left thigh involved basicervical fracture of femur (AO/OTA 31-B3) with transverse shaft fracture of femur (AO/OTA 32-A3) and extra articular supracondylar femur fracture (AO/OTA 33-A2).
First, we performed proximal femur nail antirotation in order to stabilize the fracture of the femur neck and reduce the incidence of nonunion and avascular necrosis of the femoral head in young adults. The next step to fix the shaft and distal femur fracture was to perform the distal femur locking plate. The EQ5D and Harris Hip Score questionnaires showed improvement after implementing these procedures.
Ipsilateral multi-level femur fractures have challenges and controversies in their management. In this situation, proximal femur nail antirotation and distal femur locking plates are viable options due to the condition of the injury and the higher risk of negative effects. After all fractures have been fixed, it is important to closely monitor the hip and knee joints to avoid stiffness or contracture.
同侧股骨近端、骨干和远端骨折极为罕见。治疗同侧多节段股骨骨折可能具有挑战性且存在争议。关于应首先修复的骨折类型顺序以及应使用的植入物类型，仍存在未解决的问题。
一名29岁男性患者在摩托车事故后被送往急诊科评估。患者左下肢明显畸形，主诉左大腿疼痛。术前X线片显示左大腿同侧多节段股骨骨折，包括股骨基底部骨折（AO/OTA 31-B3）、股骨干横行骨折（AO/OTA 32-A3）和股骨髁上关节外骨折（AO/OTA 33-A2）。
首先，我们进行了股骨近端抗旋髓内钉固定，以稳定股骨颈骨折并降低年轻成人股骨头不愈合和缺血性坏死的发生率。固定股骨干和远端股骨骨折的下一步是使用股骨远端锁定钢板。实施这些手术后，EQ5D和Harris髋关节评分问卷显示有所改善。
同侧多节段股骨骨折的治疗存在挑战和争议。在这种情况下，鉴于损伤情况和负面影响风险较高，股骨近端抗旋髓内钉和股骨远端锁定钢板是可行的选择。在所有骨折固定后，密切监测髋关节和膝关节以避免僵硬或挛缩非常重要。
