Putra Domy Pradana, Mustamsir Edi, Phatama Krisna Yuarno, Pradana Ananto Satya, Muhsinin Ahmad
Teaching Staff of Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia.
Teaching Staff of Orthopaedics and Traumatology Department, Faculty of Medicine, Universitas Brawijaya - Saiful Anwar General Hospital, Malang, East Java, Indonesia.
Int J Surg Case Rep. 2025 Jan;126:110732. doi: 10.1016/j.ijscr.2024.110732. Epub 2024 Dec 10.
Hip fractures are common in elderly patients, often accompanied by comorbidities. These fractures can be combined with other injuries, such as a femoral head, neck, or shaft dislocation. The cause of this complex injury is not well-established, but factors like high-energy trauma or falls from a certain height may contribute.
A 55-year-old man presented with an ipsilateral femoral head and left intertrochanteric fracture with posterior hip subluxation after a 3-m fall. This rare and complex injury was diagnosed using X-rays and CT scans. Due to the risk of complications, open reduction and internal fixation (ORIF) using a proximal femoral nail anti-rotation (PFNA) was performed. Early surgical intervention with PFNA provided stable fixation and promoted early mobilization. A 6-month follow-up showed the patient's Lower Extremity Functional Scale (LEFS) was 82.5 %, and Harris Hip Score (HHS) was 85 %, while before surgery, the patient's LEFS was 0 % and HHS was 3,85 %.
Intertrochanteric pelvic fractures are serious injuries causing avascular necrosis and traumatic osteoarthritis. They often occur with hip dislocation or acetabular wall fractures. Diagnosis is confirmed through 3D reconstruction. Management involves realigning the dislocated hip, surgical repositioning, and stabilizing the fractured femoral head. Surgical interventions include a sliding compression hip screw, side plate, or intramedullary nail. PFNA is a medical implant for complex fractures.
Open reduction and PFNA can effectively treat ipsilateral femoral head and intertrochanteric fractures with posterior hip subluxation, requiring early intervention, meticulous surgical technique, and appropriate implant selection.
髋部骨折在老年患者中很常见，常伴有合并症。这些骨折可能合并其他损伤，如股骨头、颈或骨干脱位。这种复杂损伤的原因尚未完全明确，但高能量创伤或从一定高度坠落等因素可能起作用。
一名55岁男性在从3米高处坠落 后出现同侧股骨头和左转子间骨折伴髋关节后脱位。通过X线和CT扫描诊断出这种罕见且复杂的损伤。由于存在并发症风险，采用股骨近端防旋髓内钉（PFNA）进行切开复位内固定（ORIF）。早期采用PFNA进行手术干预提供了稳定的固定并促进了早期活动。6个月的随访显示患者的下肢功能量表（LEFS）为82.5%，Harris髋关节评分（HHS）为85%，而术前患者的LEFS为0%，HHS为385%。
转子间骨盆骨折是严重损伤，可导致缺血性坏死和创伤性骨关节炎。它们常与髋关节脱位或髋臼壁骨折同时发生。通过三维重建确诊。治疗包括使脱位的髋关节复位、手术重新定位以及稳定骨折的股骨头。手术干预包括滑动加压髋螺钉、侧板或髓内钉。PFNA是用于复杂骨折的医疗植入物。
切开复位和PFNA可以有效治疗同侧股骨头和转子间骨折伴髋关节后脱位，需要早期干预、精细的手术技术和合适的植入物选择。
