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Total Hip Arthroplasty after Treatment of an Atypical Subtrochanteric Femoral Fracture in a Patient with Pycnodysostosis.

Yuasa T, Maeda K, Kaneko K, Yoshikata K - Case Rep Orthop (2015)

Bottom Line: She was of short stature with typical facial features, short stubby hands, and radiological features including open cranial sutures, obtuse mandible, and generalized skeletal sclerosis.The majority of cases of atypical subtrochanteric fractures are associated with long-term use of bisphosphonates; some occur in bisphosphonate-free patients.We performed cementless THA in combination with a plate and cables.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.

ABSTRACT
The authors describe the case of a 51-year-old woman with an osteonecrosis of her right femoral head after treatment of an atypical subtrochanteric fracture caused by pycnodysostosis. She had this fracture after a low-trauma fall. She was of short stature with typical facial features, short stubby hands, and radiological features including open cranial sutures, obtuse mandible, and generalized skeletal sclerosis. The majority of cases of atypical subtrochanteric fractures are associated with long-term use of bisphosphonates; some occur in bisphosphonate-free patients. We report a rare case of total hip arthroplasty (THA) in a patient with pycnodysostosis who developed an osteonecrosis of the femoral head after treatment of an atypical subtrochanteric femoral fracture. We performed cementless THA in combination with a plate and cables. Cementless THA is a potential intervention in a patient with pycnodysostosis; although the bone quality may have been sclerotic, healing is not a problem in this condition.

No MeSH data available.


Related in: MedlinePlus

Radiograph after total hip arthroplasty with cable and plate fixation.
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fig6: Radiograph after total hip arthroplasty with cable and plate fixation.

Mentions: The patient underwent cementless total hip arthroplasty using R3 acetabular system (Smith & Nephew, London, UK) and MODULUS stem with a modular neck (Lima Corporate, Udine, Italy) followed by fixation of the fracture with cable and plate system (Figure 6). This stem has the 5° finned stem taper which ensures optimal fixation across a wide range of femoral morphologies. Pathological examination of the femoral head was consistent with an osteonecrosis. Three weeks postoperatively, full-weight bearing was permitted and she could walk with a walking frame. At final follow-up, one year later, her symptoms had resolved and the patient had resumed normal activities (Harris hip score, 84). Radiographs showed no migration of implant (Figure 7).


Total Hip Arthroplasty after Treatment of an Atypical Subtrochanteric Femoral Fracture in a Patient with Pycnodysostosis.

Yuasa T, Maeda K, Kaneko K, Yoshikata K - Case Rep Orthop (2015)

Radiograph after total hip arthroplasty with cable and plate fixation.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4581509&req=5

fig6: Radiograph after total hip arthroplasty with cable and plate fixation.
Mentions: The patient underwent cementless total hip arthroplasty using R3 acetabular system (Smith & Nephew, London, UK) and MODULUS stem with a modular neck (Lima Corporate, Udine, Italy) followed by fixation of the fracture with cable and plate system (Figure 6). This stem has the 5° finned stem taper which ensures optimal fixation across a wide range of femoral morphologies. Pathological examination of the femoral head was consistent with an osteonecrosis. Three weeks postoperatively, full-weight bearing was permitted and she could walk with a walking frame. At final follow-up, one year later, her symptoms had resolved and the patient had resumed normal activities (Harris hip score, 84). Radiographs showed no migration of implant (Figure 7).

Bottom Line: She was of short stature with typical facial features, short stubby hands, and radiological features including open cranial sutures, obtuse mandible, and generalized skeletal sclerosis.The majority of cases of atypical subtrochanteric fractures are associated with long-term use of bisphosphonates; some occur in bisphosphonate-free patients.We performed cementless THA in combination with a plate and cables.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.

ABSTRACT
The authors describe the case of a 51-year-old woman with an osteonecrosis of her right femoral head after treatment of an atypical subtrochanteric fracture caused by pycnodysostosis. She had this fracture after a low-trauma fall. She was of short stature with typical facial features, short stubby hands, and radiological features including open cranial sutures, obtuse mandible, and generalized skeletal sclerosis. The majority of cases of atypical subtrochanteric fractures are associated with long-term use of bisphosphonates; some occur in bisphosphonate-free patients. We report a rare case of total hip arthroplasty (THA) in a patient with pycnodysostosis who developed an osteonecrosis of the femoral head after treatment of an atypical subtrochanteric femoral fracture. We performed cementless THA in combination with a plate and cables. Cementless THA is a potential intervention in a patient with pycnodysostosis; although the bone quality may have been sclerotic, healing is not a problem in this condition.

No MeSH data available.


Related in: MedlinePlus