Plomp Raul G, Ten Duis Kaj, Meesters Anne M L, IJpma Frank F A
Department of Trauma Surgery, University Medical Center Groningen, Groningen, The Netherlands.
3D Lab, University Medical Center Groningen, Groningen, The Netherlands.
Eur J Orthop Surg Traumatol. 2025 Apr 12;35(1):157. doi: 10.1007/s00590-025-04283-8.
Fractures through an arthrodesed hip are rare and challenging. The aim of the study is (1) to explore whether 3D-planned percutaneous screw fixation of fractures in hip arthrodesis is a viable minimally invasive surgical option for geriatric patients and (2) to standardize surgical treatment by providing a comprehensive overview of the literature and propose a treatment algorithm.
We presented a case series of patients with an acute fracture in a previous hip arthrodesis treated in a level 1 trauma centre in 2024. Furthermore, we conducted a systematic review on fractures in hip arthrodesis from 1970 to 2023.
We presented three cases treated for a fracture in an arthrodesed hip. Two patients with a proximal/medial fracture to the acetabulum were operated with 3D-planned percutaneous cannulated screws, and one patient with an intertrochanteric fracture was operated with a DHS system. The systematic review resulted in an overview of 16 case series on fractures in hip arthrodesis treated with various surgical techniques, each with its pros and cons; cannulated screws, DHS system, intramedullary nailing and plate osteosynthesis.
Acute fractures in arthrodesed hips in fragile geriatric patients can be treated minimally invasively with 3D-planned percutaneous screw fixation. This technique is most suitable for femoral neck fracture types. Alternative surgical techniques include DHS, intramedullary nailing, plate osteosynthesis or conversion to total hip arthroplasty, for which a treatment algorithm is provided.
髋关节融合术后骨折罕见且具有挑战性。本研究的目的是：（1）探讨三维规划下经皮螺钉固定髋关节融合术后骨折对于老年患者是否是一种可行的微创手术选择；（2）通过全面综述文献来规范手术治疗并提出治疗算法。
我们展示了2024年在一级创伤中心治疗的一系列既往髋关节融合术后急性骨折患者的病例。此外，我们对1970年至2023年期间髋关节融合术后骨折进行了系统综述。
我们展示了3例髋关节融合术后骨折的治疗病例。2例髋臼近端/内侧骨折患者采用三维规划下经皮空心螺钉手术治疗，1例转子间骨折患者采用动力髋螺钉（DHS）系统手术治疗。系统综述得出了16个关于髋关节融合术后骨折采用各种手术技术治疗的病例系列综述，每种技术都有其优缺点；空心螺钉、DHS系统、髓内钉固定和钢板内固定。
脆弱老年患者髋关节融合术后的急性骨折可采用三维规划下经皮螺钉固定进行微创治疗。该技术最适合股骨颈骨折类型。其他手术技术包括DHS、髓内钉固定、钢板内固定或转换为全髋关节置换术，并提供了相应的治疗算法。
