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Case Reports
. 2024 Mar 21:51:100999.
doi: 10.1016/j.tcr.2024.100999. eCollection 2024 Jun.

Trifocal femur fracture with intracapsular femoral neck, open diaphyseal, and distal complete articular fractures

Carly A Robinson  1 , Ellen Fitzpatrick  2 , Gillian Soles  2 , Augustine Saiz  2 , Mark A Lee  2 , Sean T Campbell  2
Affiliations
Case Reports

Trifocal femur fracture with intracapsular femoral neck, open diaphyseal, and distal complete articular fractures

Carly A Robinson et al. Trauma Case Rep. .

Abstract

We describe a trifocal femur injury with intracapsular femoral neck fracture, diaphyseal fracture with bone loss, and distal complete articular (AO/OTA C type) fracture, an injury rarely described in the literature. Surgical management utilized a not-yet-reported implant combination: screw-side plate device for the intracapsular femoral neck, retrograde nail for the diaphysis, and lag screws plus mini fragment buttress plating for the distal fracture. The patient had uneventful fracture union with no changes in alignment. Given the rarity and complexity of this injury, there is little consensus on surgical technique and implant choice. This case demonstrates a modernized approach that may be useful for surgeons who encounter similar fracture patterns in their practice.

Keywords: Intra-articular; Intra-capsular; Multifocal fracture; Open fracture; Trifocal femur fracture.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Robinson and Fitzpatrick declare that they have no competing interests. Soles reports the following: Depuy, A Johnson & Johnson Company (Paid consultant), Orthopaedic Trauma Association (Board or committee member). Saiz reports the following: AAOS (Board or committee member), Orthopaedic Research Society (Board or committee member), Orthopaedic Trauma Association (Board or committee member). Lee reports the following: AO Foundation (Board or committee member), Globus Medical (IP royalties), Osteocentric (Stock or stock options), Osteocentric/SMV (Paid consultant), Synthes (Paid consultant, presenter, or speaker). Campbell reports the following: AAOS (Board or committee member), NSITE Medical INC. (Stock or stock options), Orthopaedic Trauma Association (Board or committee member), Synthes (Paid consultant, presenter, or speaker), Takeda Pharmaceuticals (Research support).

Figures

Fig. 1
Fig. 1
Trifocal femur fracture including displaced transcervical femoral neck fracture (A), comminuted, open diaphyseal fracture (B), and complete articular distal femur fracture (B-C).
Fig. 2
Fig. 2
Post-operative images demonstrating the use of a sliding femoral neck system for the proximal femur (A), retrograde nail for the diaphysis (B), and lag screws plus mini-plating for the distal intraarticular fracture (C).
Fig. 3
Fig. 3
Interval fracture healing shown on anteroposterior x-rays taken at 2 months post-op (A), 3 months post-op (B), 6 months post-op (C), and 13 months post-op (D) clinic visits. X-ray at 13 months (D) demonstrated intact hardware and well-healed femoral neck, diaphyseal, and distal femur fractures.
Fig. 4
Fig. 4
Interval fracture healing shown on lateral x-rays taken at 2 months post-op (A), 3 months post-op (B), 6 months post-op (C), and 13 months post-op (D) clinic visits. X-ray at 13 months (D) demonstrated intact hardware and well-healed femoral neck, diaphyseal, and distal femur fractures.
See this image and copyright information in PMC

References

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