Fracture Diaphyseal Femur in a Case of Ipsilateral Excision Arthroplasty of Hip: Report of Two Cases with Description of an Unusual Injury Pattern, Mechanism, and Clinical Decision-making in Management.
BACKGROUND
Although fracture diaphyseal femur is commonly seen in orthopedic practice, its association with ipsilateral resection arthroplasty of hip/pseudarthrosis of neck is rare. The technique of excision arthroplasty has undergone modification with emphasis on preserving as much bone as possible. However, it is not always possible to preserve bone while removing the earlier prosthesis and cement. This often leads to extensive proximal bone loss. Associated ipsilateral fracture femur presents a unique scenario. Till date, only one case report is published highlighting its surgical management.


METHODS
We report two cases of diaphyseal fracture femur associated with resection arthroplasty of hip at subtrochanteric level with greater trochanter as a separate fragment (Case 1) and other with pseudarthrosis of the neck of femur with intact greater trochanter (Case 2). The first case was operated with surface fixation, whereas the second was operated with closed antegrade intramedullary nail.


CONCLUSIONS
Decision-making and formulating treatment plan includes taking various factors into account such as level of resection arthroplasty of hip/pseudarthrosis of neck, status of greater trochanter (intact or separate fragment), osteoporosis, and post-operative ambulation and rehabilitation. In this report, we highlight the unusual occurrence, probable mechanism of injury, risk factors for fracture, and decision-making in the surgical management of such a condition.
Department of Orthopaedics, R. N. Cooper Hospital, Mumbai, Maharashtra, India.
Kunal
K
Shah
Department of Orthopaedics, R. N. Cooper Hospital, Mumbai, Maharashtra, India.
Tushar
T
Ubale
Department of Orthopaedics, R. N. Cooper Hospital, Mumbai, Maharashtra, India.
Rahematullah
R
Abdul
Department of Orthopaedics, Sushrut Hospital, Mumbai, Maharashtra, India.
Vaibhav
V
Kasodekar
Department of Orthopaedics, R. N. Cooper Hospital, Mumbai, Maharashtra, India.
Ashish
A
Assudani
Department of Orthopaedics, R. N. Cooper Hospital, Mumbai, Maharashtra, India.
Kiran
K
Makwana
Diaphysis fracture; intramedullary nailing; pseudarthrosis; resection arthroplasty; surface fixation