Non-union fracture neck femur in a young patient

Interesting Rare Case Pictures

Non-union fracture neck femur in a young patient

Raju Vaishya a,*, Vipul Vijay b, K.C. Kapil Mani b, Vikas Birla b

a Prof, Department of Orthopaedic Surgery, Indraprastha Apollo Hospitals, New Delhi, IndiabDepartment of Orthopaedic Surgery, Indraprastha Apollo Hospitals, New Delhi, India

1. Case report

An 18-year-old boy fell 1 year ago from a tree and sustained

righthip injury,whichwas treatedby traction.Atpresentation,

15 years ago, hehadpain, deformity and 300 shortening andwas

unable tobearweighton right leg.X-rayof the righthip showed

non-union with resorption of neck of femur and proximal

migration of femur (Fig. 1), but the head seemed viable.

A corrective valgus osteotomy with the fixation of fracture

was done using a Dynamic Hip Screw (DHS)with a 135� angle 4

hole plate. The patient did very well and both the osteotomy

and fracture united without any avascular necrosis of the

femoral head (Fig. 2). At 15 years follow up, the patient came

for a routine implant removal (Fig. 3), when he was totally

asymptomatic and has had only 1 cm of residual shortening of

right hip and almost full range of hip movements. The im-

plants were removed without any significant event (Fig. 4).

Fracture neck of femur in young is rare and usually occur

due to severe injuries like road traffic accident (RTA), fall from

height etc. If the displaced fractures are not treated early then

it is often associated with complications. Non-union is one of

the commonest complications. Treatment of non-union of

these fractures in young is quite challenging. An attempt to

save the natural femoral head and hip joint is a priority and

hence corrective valgus osteotomy with fixation of the frac-

ture with stable implant is a good choice and may achieve

union and preserve the natural hip joint, as it was in our case.

Joint replacement may be a secondary choice but considering

the young age of these patients, an attempt to fix the fracture

along with a corrective osteotomymust be considered first, as

it may preserve a natural hip joint.

Fig. 1 e Non-union of fracture neck femur with proximal

migration of the trochanter.

* Corresponding author.E-mail address: raju.vaishya@gmail.com (R. Vaishya).

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier .com/locate/apme

a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1e2

0976-0016/$ e see front matter Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.http://dx.doi.org/10.1016/j.apme.2014.01.005

Please cite this article in press as: Vaishya R, et al., Non-union fracture neck femur in a young patient, Apollo Medicine (2014),http://dx.doi.org/10.1016/j.apme.2014.01.005

2. Learning points

� Fracture neck of femur in children are rare injuries and are

often caused by severe trauma

� Early surgical treatment is essential for better outcomes

� Neglected cases may need corrective osteotomy and

fixation

3. Image quiz

What is diagnosis of this condition?

1. Dislocation of the hip

2. Fresh fracture neck of the femur

3. Non-union of fracture neck of femur

4. Dysplasia of the hip

Ans: Non-union of the fracture neck of femur with

resorption of neck and proximal migration of the trochanter.

Fig. 2 e Early post op radiograph showing well fixed

osteotomy and uniting fracture.

Fig. 3 e 15 year follow up X-ray showing well united and

remodelled fracture with implants in situ.

Fig. 4 e X-ray showing hip joint, with united fracture after

removal of implants.

a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1e22

Please cite this article in press as: Vaishya R, et al., Non-union fracture neck femur in a young patient, Apollo Medicine (2014),http://dx.doi.org/10.1016/j.apme.2014.01.005

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