CAse #84: The elderly woman who fell
This elderly woman fell in the bathroom and presented to the hospital complaining of left hip pain.
Here are her Xrays:
Questions:
1. Describe the affected area.
2. What procedure was done for her?
Mon, 060709 @ 0700
Categories: Patient of the Week, Xray of the Week
a) fracture of the proximal femur shaft
b) total hip replacement
1. X-ray radiograph of the pelvic region. Poor bone quality and multiple osteolytic lesion on pelvic bone present. Complete oblique subtrochanteric fracture of left femur, displaced, angulated and laterally rotated. *I’m not too sure about the rotation, seems to me like the distal end of the fracture doesn’t align with the proximal end of the fracture*
2. Intramedulary nail with no interlocking of the left femur.
*my first attempt. Don’t shoot me, I nub T_T*
1. Oblique Subtrochanteric fracture of the left femur with medial displacement, generally appear osteoporosis. Explains the trivial trauma.
2. Open reduction and close fixation with intramedullary nail, but I am wondering why there isn’t any interlocking nails to anchor the nail. and I don’t know why there is hyperdensity of the head of left femur.
Usual Prof Harwant’s method:
1. Fracture seen below the left subtrochanteric region (appears to be moth eaten appearance suggestive of osteolytic lesion) with medial displacement.
2. Bone quality osteopenic.
3. Soft tissue swelling of the left thigh.
4. Adult skeleton
Impression: left subtrochanteric fracture most likely due to pathological fracture (osteoporosis) in an elderly patient. Differential diagnosis would be osteolytic lesions producing cancers.
Procedure done:
Intramedullary nailing with bending of the initial part to fit into the femoral head. (Not sure what is the name of the nail)
*Doesn’t look like dynamic hip screw due to the lacking of the “screw” appearance.
*Looks like there is also periosteal reaction seen after surgery.
*Cannot determine any shortening unless the whole lower limb underwent imaging within a single piece of radiograph.
1. Subtrochanteric fracture of the left femur with displacement
2. Open reduction and internal fixation by placement of a dynamic compression screw.
1) Subtrochanteric fracture of left neck of femur with shortening.
2) Dynamic Hip Screw.