Orthopaedic case study 2

dr.qinan

This patient suffered a fracture of the neck of the femur. Initially this was treated with a dynamic hip screw. Due to the nature of the fracture, the blood supply to the head of femur was much reduced (avascular necrosis). Within 12 months this lead to collapse of the head , with the metal passing into the joint and damaging the acetabulum. The patient was then given a total hip replacement (including the acetabulum).

	This 58 year-old woman suffered a left grade III Transcervical fracture in July 1975. The fracture was treated by reduction and fixation with a dynamic hip screw.
	In May 1976, the patient developed pain in the hip.X-ray showed late segmental collapse, avascularity of the head of femur and deformation of the acetabulum, with the nail protruding through the collapsed head of femur.
	The hip was treated by total joint replacement of the Charney type in view of the acetabular deformity. This produced a satisfactory result. This case illustrates why a replacement femoral head (hemiarthroplasty) is the current recommended treatment for a type III subcapital fracture. The elderly patient in this case study required a total hip replacement, her second major operation after the intial unsucceful attempted fixation. With hind sight, a hemiarthroplasty would have resulted in a much more favourable outcome