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Conservative treatment of a femoral neck fracture following nail removal

With increased longevity, the management of fragility fractures in the elderly is becoming more frequent. In particular, hip fractures have considerable importance due to the significant morbidity and mortality. A 67-year-old woman underwent intramedullary nail (IMN) removal inserted for a pertrocha...

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Autores principales: Legnani, Claudio, Dondi, Alessandra, Pietrogrande, Luca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952413/
https://www.ncbi.nlm.nih.gov/pubmed/24672194
http://dx.doi.org/10.4103/0976-7800.118995
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author Legnani, Claudio
Dondi, Alessandra
Pietrogrande, Luca
author_facet Legnani, Claudio
Dondi, Alessandra
Pietrogrande, Luca
author_sort Legnani, Claudio
collection PubMed
description With increased longevity, the management of fragility fractures in the elderly is becoming more frequent. In particular, hip fractures have considerable importance due to the significant morbidity and mortality. A 67-year-old woman underwent intramedullary nail (IMN) removal inserted for a pertrochanteric fracture that had occurred 20 months earlier. This was indicated due to continuous discomfort related to the protruding apex of the implant over the great trochanter. Due to pain persistence two days after surgery, a computed tomography (CT) scan was performed, documenting a minimally displaced impacted subcapital femoral neck fracture. Conservative management with close radiographic follow-up was conducted. After six months, the patient had returned to previous daily activities and a satisfactory range of motion was achieved without pain on walking. The purpose of our paper is to discuss the decision of removing hardware in the elderly osteoporotic patient and to analyze the possibility to conservatively treat an impacted minimally displaced subcapital fracture occurring after the removal of an IMN inserted previously for the treatment of a trochanteric fracture. In the elderly population with decreased bone quality, the removal of intramedullary implants of the proximal femur should be carefully evaluated, and osteoporotic patients undergoing reduction and fixation of femoral fractures should be encouraged to start antiosteoporotic therapy (bisphosphonate, teriparatide) to reduce the risk of further bone loss. Conservative treatment should be considered for the management of lesser symptomatic minimally displaced impacted fractures, where the inherent stability of the fracture allows rapid healing without further surgical attempts.
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spelling pubmed-39524132014-03-26 Conservative treatment of a femoral neck fracture following nail removal Legnani, Claudio Dondi, Alessandra Pietrogrande, Luca J Midlife Health Case Report With increased longevity, the management of fragility fractures in the elderly is becoming more frequent. In particular, hip fractures have considerable importance due to the significant morbidity and mortality. A 67-year-old woman underwent intramedullary nail (IMN) removal inserted for a pertrochanteric fracture that had occurred 20 months earlier. This was indicated due to continuous discomfort related to the protruding apex of the implant over the great trochanter. Due to pain persistence two days after surgery, a computed tomography (CT) scan was performed, documenting a minimally displaced impacted subcapital femoral neck fracture. Conservative management with close radiographic follow-up was conducted. After six months, the patient had returned to previous daily activities and a satisfactory range of motion was achieved without pain on walking. The purpose of our paper is to discuss the decision of removing hardware in the elderly osteoporotic patient and to analyze the possibility to conservatively treat an impacted minimally displaced subcapital fracture occurring after the removal of an IMN inserted previously for the treatment of a trochanteric fracture. In the elderly population with decreased bone quality, the removal of intramedullary implants of the proximal femur should be carefully evaluated, and osteoporotic patients undergoing reduction and fixation of femoral fractures should be encouraged to start antiosteoporotic therapy (bisphosphonate, teriparatide) to reduce the risk of further bone loss. Conservative treatment should be considered for the management of lesser symptomatic minimally displaced impacted fractures, where the inherent stability of the fracture allows rapid healing without further surgical attempts. Medknow Publications & Media Pvt Ltd 2013 /pmc/articles/PMC3952413/ /pubmed/24672194 http://dx.doi.org/10.4103/0976-7800.118995 Text en Copyright: © Journal of Mid-life Health http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Legnani, Claudio
Dondi, Alessandra
Pietrogrande, Luca
Conservative treatment of a femoral neck fracture following nail removal
title Conservative treatment of a femoral neck fracture following nail removal
title_full Conservative treatment of a femoral neck fracture following nail removal
title_fullStr Conservative treatment of a femoral neck fracture following nail removal
title_full_unstemmed Conservative treatment of a femoral neck fracture following nail removal
title_short Conservative treatment of a femoral neck fracture following nail removal
title_sort conservative treatment of a femoral neck fracture following nail removal
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952413/
https://www.ncbi.nlm.nih.gov/pubmed/24672194
http://dx.doi.org/10.4103/0976-7800.118995
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