Intertrochanteric fracture under an arthrodesed hip

PATIENT: Female, 30 PRIMARY DIAGNOSIS: Intertrochanteric fracture under an arthrodesed hip CO-EXISTING DISEASES: Developmental dysplasia of the hip MEDICATION: Pain • inability to walk CLINICAL PROCEDURE: Open reduction and internal fixation SPECIALTY: Orthopedics and traumatology OBJECTIVE: Rare disease, Unusual setting of medical care BACKGROUND: An intertrochanteric fracture among elderly people is common, but it is rare to see such a fracture under a longstanding hip arthrodesis. Its surgical management represents a real challenge to orthopedic surgeons. CASE REPORT: A 30-year-old female teacher with long-standing hip arthrodesis was involved in a traffic accident. Clinical and radiological examination revealed the presence of a displaced intertrochanteric fracture under an arthrodesed hip and high neck shaft angle. Before embarking on surgery, we have to consider many factors such as patient personality (a young active and ambitious woman) and the mature of the fracture (a displaced fracture, coxa valga, and atrophied muscles). After a deep discussion and evaluation of the available devices, we selected a heavy duty locked plate and cannulated screws to fix the fracture. CONCLUSIONS: Because of the rarity of intertrochanteric fracture under an arthrodesis hip, the proper surgical treatment is controversial. Nevertheless, we were fortunate in successfully treating this unusual fracture using a locked plate and cannulated screws, which are implants that can be useful in treatment of such fractures.