Ipsilateral diaphyseal femur fracture after resection arthroplasty

Proximal femur shaft fracture in a case of ipsilateral resection arthroplasty of a tuberculous hip - A rare case report

Femur shaft fracture is a common entity in orthopaedic practice, but how commonly does one encounter a subtrochanteric femur fracture in ipsilateral resection arthroplasty of a tuberculous hip after a decade of uneventful unassisted ambulation post resection procedure ? Till date only 2 patients have been reported worldwide with femur diaphyseal fracture with a history of ipsilateral resection arthroplasty all performed within a year of fracture occurrence. The intriguing factor of our case was the fact that post resection, patient was ambulatory for a decade and the fracture occurred at a subtrochanteric level. Thus we report a case of 35 year old male with subtrochanteric femur fracture due to minor trauma to right thigh, with a history of tuberculous arthritis of right hip for which surgical management in the form of resection arthroplasty was done 10 years back. After a thoughtful decision making and plan formulation we managed the patient with surface fixation with a pre contoured GT (greater trochanter) configuration plate after taking into consideration status of intact GT, osteoporosis, pseudoarthrosis level and post operative ambulation and rehabilitation.

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

INTRODUCTION

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.

CASE REPORT

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.

CONCLUSION

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.