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KMID : 1120320170030000091
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Osteoporosis and Sarcopenia
2017 Volume.3 No. 0 p.91 ~ p.91
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Implant of choice for osteoporotic basicervical femoral neck fracture in a young patient with demineralised bone disease
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Choo P.T.
Kasim N.S.
Chopra S.
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Abstract
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Introduction: Demineralised bone disease is commonly seen in young patient with chronic kidney disease. Trivial injury leads to femoral neck fracture which can be difficult to fix due to bony deformity. Patient’s age and neck-shaft angle are taken into consideration for choice of implant.
Case study: A 27 year-old gentleman presented to us for base of femoral neck fracture with extension to greater trochanter following a fall from bed. Comorbid history was significant with end stage renal failure (ESRF) since childhood and secondary hyperparathyroidism (intact parathyroid hormone, iPTH: 2197 pg/ml). The fracture is confirmed with CT scan of pelvis (Figure 1,2). The neck-shaft angle of femur is 98°. Dynamic condylar screw (DCS) was used for fracture fixation (Figure 3).
Results: Patient started partial weight and full weight ambulation at 6th week and 12th week post operation respectively. No displacement seen at 6 months post surgery.
Discussions: Osteosynthesis surgery is preferred in young patient with femoral neck fracture instead of endoprosthesis. Basicervical fracture shares the similar biomechanics as stable intertrochanteric fracture except for lack of muscular attachment to proximal fragments. Dynamic screw device is superior compared to multiple cancellous screw fixation and proximal femoral locking plate(1,2). Dynamic hip screw (DHS) is commonly used for basicervical fracture, however, it does not suit him with reduced femoral neck-shaft angle. Derotational screw should be inserted to achieve three plane stability(2) but it’s not performed due to lack of space superiorly.
Conclusion: In patient with demineralised bone disease, as the weight bearing bone is osteoporotic and deformed with reduced femoral neck-shaft angle, basicervical fracture should be treated using a smaller barrel angle sliding screw device. In addition, an extra derotational screw should be inserted whenever possible to achieve rotational stability.
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