Fracture neck Femur-Comedy Of Errors

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learning curve, fracture neck femur, common mistake in orthopaedics, fracture management

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Fracture neck Femur-Comedy Of Errors

  1. 1. Vinod Naneria Consultant, Orthopaedics Choithram Hospital & Research Centre Indore, MP, India Comedy of Errors
  2. 2. Case Summary <ul><li>A 75 years old female </li></ul><ul><li>Occasional pain right hip </li></ul><ul><li>X-ray Hip showing incomplete trans-cervical fracture neck of femur. </li></ul>
  3. 3. Plain X-ray Incomplete fracture neck of femur Normal serum chemistry
  4. 4. Three Knowles pins for prophylactic fixation Mobilization with walker started
  5. 5. Developed sub-trochanteric extension following loss of balance
  6. 6. Fixation by DHS after reduction and stabilization by one inter-fragmentary screws
  7. 7. Plate bending started Pain persisted Ambulation continued
  8. 8. Pain persisted Ambulation continued Hoping union
  9. 9. Plate failed Severe pain Difficulty in ambulation
  10. 10. Reconstruction nailing
  11. 11. Moral of the story & lessons learned <ul><li>Never leave an empty hole in cortical bone. </li></ul><ul><li>Avoid making entry point below the level of lesser trochanter for multiple pinning. </li></ul><ul><li>Do not rely on inter-fragmentary screws in sub-trochanteric fracture. </li></ul><ul><li>Do not wait for plate to brake once failure is evident. </li></ul>
  12. 12. DISCLAIMER • Information contained and transmitted by this presentation is based on personal experience and collection of cases at Choithram Hospital & Research centre, Indore, India, during last 25 years. • It is intended for use only by the students of orthopaedic surgery. Many GIF files are taken from Internet. • Views and opinion expressed in this presentation are personal opinion. • Depending upon the x-rays and clinical presentations viewers can make their own opinion. • For any confusion please contact the sole author for clarification. Every body is allowed to copy or download and use the material best suited to him. I am not responsible for any controversies arise out of this presentation. • For any correction or suggestion please contact [email_address]

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