Subtrochanteric Femur Fracture after Multiple Drilling for Treatment of Nontraumatic Osteonecrosis of the Femoral Head - A Case Report -

Jong Won Kim; Hyun-Soo Park; Jong-Deuk Rha; Young-Soo Jang; Jae-Wook Jung; Jin-Phil Yang; Jae-Hyuk Choi

doi:10.5371/jkhs.2011.23.2.155

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Kim, Park, Rha, Jang, Jung, Yang, and Choi: Subtrochanteric Femur Fracture after Multiple Drilling for Treatment of Nontraumatic Osteonecrosis of the Femoral Head - A Case Report -

Case Report

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2011; 23(2): 155-160.

Published online: 30 June 2011

DOI: https://doi.org/10.5371/jkhs.2011.23.2.155

Subtrochanteric Femur Fracture after Multiple Drilling for Treatment of Nontraumatic Osteonecrosis of the Femoral Head - A Case Report -

Jong Won Kim, MD, Hyun-Soo Park, MD, Jong-Deuk Rha, MD, Young-Soo Jang, MD, Jae-Wook Jung, MD, Jin-Phil Yang, MD, Jae-Hyuk Choi, MD

Department of Orthopedic Surgery, Hanil General Hospital, Seoul, Korea.

Address reprint request to Hyun-Soo Park, MD. Department of Orthopedic Surgery, Hanil General Hospital, 388-1 Ssangmoon 3-dong, Dobong-gu, Seoul 132-703 Korea. TEL: +82-2-901-3078, FAX: +82-2-900-1745, deanzang2@hanmail.net

Received 15 January 2011 Revised 13 June 2011 Accepted 15 June 2011

Abstract

Multiple drilling of the femoral head is a commonly-used surgical technique for the treatment of osteonecrosis. Several holes are drilled into the femoral head using a small-diameter Steinmann pin. This decompression technique promotes revascularization and regeneration of necrotic tissue in the femoral head. Known complications are heterotopic ossification and femoral subtrochanteric fractures, although these have only been rarely reported. Our case study focuses on a subtrochanteric fracture 6 weeks after a multiple drilling operation.

Keywords: Femoral head, Subtrochanteric fracture, Osteonecrosis, Multiple drilling

Figures and Tables

Fig. 1

Anteroposterior and frog-lateral view of both hip radiographs show sclerotic change of right femoral head.

Fig. 2

(A) Coronal T1-weighted (SE; TR629/TE10 msec) image shows decreased signal at subchondral location. Also it shows osteonecrotic segment separated from normal bone by low signal intensity. (B) Coronal T2-weighted image shows increased signal at subchondral location of necrotic tissue.

Fig. 3

Immediate postoperative anteroposterior and lateral radiographs of the right hip show multiple radiolucent lines those from lateral cortex of proximal femur to femoral head.

Fig. 4

Plain radiograph after 6 weeks of operation shows multiple lines without any bone destruction or fracture.

Fig. 5

(A) Anteroposterior radiograph of right hip shows transverse fracture line at subtrochanteric area and it started just inferior of drilling site. (B) Lateral radiograph of right hip shows complete fracture line and posterior displacement of distal fragment of proximal femur.

Fig. 6

Immediate postoperative anteroposterior and lateral radiographs of the right hip show intramedullary fixation status using PFNA II (Synthes, Oberdorf, Swiss).

Fig. 7

Plain radiograph after 1 year of operation shows reduction status periosteal callus formation at fracture site and also fracture line is almost obliterated.

Fig. 8

Dual Energy X-ray Absorptiometry of the patient shows T score 2.5 of bone densitometry.

References

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