Operative fixation of a subtrochanteric fracture in a patient with previous spontaneous hip fusion

Tan KG, Sathappan SS
Correspondence: Dr Sathappan S Sathappan, sathappan@ttsh.com.sg

ABSTRACT
Patients with a fused hip can present with various clinical problems, such as contralateral hip arthritis, ipsilateral knee arthritis and degenerative disc disease. There are significant deforming forces at the proximal femur in patients with a fused hip who have ipsilateral subtrochanteric fractures. We report a 66-year-old patient with a spontaneously fused right hip, who sustained an ipsilateral comminuted proximal femoral fracture secondary to a road traffic accident. Optimal operative fixation of this patient posed as a surgical challenge. We discuss the management options in this paper. Intramedullary nailing was used so as to minimise the blood loss and because of its favourable biomechanical characteristics. The patient had postoperative femoral nerve neuropraxia that eventually resolved. In patients with a fused hip who have ipsilateral subtrochanteric fractures, retrograde nailing of such fractures can serve as an optimal treatment option. However, femoral nerve palsy can be a potential complication.

Keywords: femoral nerve palsy, hip fusion, intramedullary nailing, proximal femur, retrograde, shaft fracture, subtrochanteric
Singapore Med J 2010; 51(6): e107-e110