Low-energy atypical femoral shaft and ipsilateral neck fracture: a rare association

Abstract

This reports a case of a low-energy ipsilateral femoral shaft and neck fracture in a 69-year-old woman with vitamin D deficiency, who was taking long-term steroids and bisphosphonates. This is a fracture more commonly associated with a high-energy trauma. However, with an ageing global population and an increasing prevalence of bone insufficiency, we predict the incidence of this presentation to increase. Long-term bisphosphonate therapy has been associated with bone insufficiency and an increased rate of delayed union, adding to the complexity of management in these patients. There is currently no consensus regarding the choice of optimal implant or fixation technique to treat this challenging fracture pattern. We discuss the considerations that led to our management approach of a non-overlapping dynamic hip screw and femoral shaft plate construct which achieved uneventful bone healing and a good functional outcome within the first year of follow-up.

Keywords: orthopaedic and trauma surgery; orthopaedics.

Figure 1

(A) AP pelvis demonstrating displaced intracapsular fracture. (B) AP femur displaying atypical features of the fracture. (C) Lateral hip. (D) Lateral femur. AP, anteroposterior.

Figure 2

(A) AP femur demonstrating fixation with 9-hole AxSOS Stryker plate (1 year postoperatively). (B) AP pelvis demonstrating 2-hole DHS and derotation screw with no evidence of avascular necrosis of hip. (C) Lateral femur and lateral hip demonstrating dual implants with satisfactory union. AP, anteroposterior; DHS, dynamic hip screw.