Ipsilateral Fracture Shaft Femur with Neglected Dislocation of Prosthesis: A Case Report

Introduction: Neglected hip dislocation is rare in today’s world and after prosthesis replacement even rarer finding. However such patients may not report to surgeons until they develop secondary complications. Management of such patient’s is a challenge to the treating surgeon and need to be tailor...

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Main Authors: Mantu Jain, Amar Jyoti Bihari
Format: Article
Language:English
Published: Indian Orthopaedic Research Group 2013-10-01
Series:Journal of Orthopaedic Case Reports
Online Access:http://www.jocr.co.in/wp/2013/10/11/2250-0685-127-fulltext/
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spelling doaj-34a9c5bd8cc24b7eabc7e6879fc06e512020-11-24T23:57:31ZengIndian Orthopaedic Research GroupJournal of Orthopaedic Case Reports2250-06852013-10-0134263010.13107/jocr.2250-0685.127 Ipsilateral Fracture Shaft Femur with Neglected Dislocation of Prosthesis: A Case ReportMantu Jain0Amar Jyoti Bihari1Amar Jyoti Bihari2Department of Orthopaedics, Hitec medical college and Hospital, Rourkela, Odisha, IndiaDepartment of Orthopaedics, Hitec medical college and Hospital, Rourkela, Odisha, India.Department of Anesthesia, Ispat General Hospital, Rourkela, Odisha, IndiaIntroduction: Neglected hip dislocation is rare in today’s world and after prosthesis replacement even rarer finding. However such patients may not report to surgeons until they develop secondary complications. Management of such patient’s is a challenge to the treating surgeon and need to be tailored suiting to patient’s demands, expectations and constraints of financial resources. We did not find a similar case in the electronic and print media and therefore report this case which was innovatively managed. Case Report: A 60 year farmer presented with fracture shaft femur and ipsilateral dislocation prosthesis of right hip. He had a hemiarthroplasty done for fracture neck of femur in the past but used to walk with a lurch since he started to ambulate after discharge. However he was satisfied despite “some problems” which had caused shortening of his limb. The patient was informed of the various treatment options and their possible complications. He expressed his inability to afford a Total Hip Arthroplasty (THA) at any stage and consented for other options discussed with him. The patient was positioned supine and adductor tenotomy done. Next he was positioned laterally and the fracture was fixed with heavy duty broad dynamic compression plate and screws. The wound was temporarily closed. Now through the previous scar via posterior approach the hip was exposed. The prosthesis was found to be firmly fixed to the proximal femur. The acetabulum was cleared with fibrous tissue. All attempts the prosthesis to relocate the prosthesis failed after several attempts and it was best decided to leave alone. Post operatively period was uneventful. At follow up he refused for any further manoeuvre in future inform of heavy traction and attempts to reduce the same. At one year when he was walking unaided and his X-rays showed that fracture had well united his SF-36 score was PCS – 49.6 and MCS – 51.9. Conclusion: Ipsilateral shaft femur fracture in chronically dislocated prosthesis, done for fracture neck of femur is a rare clinical entity. Increased stress transfers due to dislocation compounded with osteoporosis makes the shaft vulnerable to fracture even with low velocity injury as in our case. Though fixation of fracture shaft femur is clear and straightforward; management of neglected prosthesis dislocation have to be guided by patient’s level of expectations and subjective contentment to adaptation to the altered hip state which influence the overall functional outcome. Keywords: Neglected dislocation, ipsilateral femoral fracture, hip arthroplasty.http://www.jocr.co.in/wp/2013/10/11/2250-0685-127-fulltext/
collection DOAJ
language English
format Article
sources DOAJ
author Mantu Jain
Amar Jyoti Bihari
Amar Jyoti Bihari
spellingShingle Mantu Jain
Amar Jyoti Bihari
Amar Jyoti Bihari
Ipsilateral Fracture Shaft Femur with Neglected Dislocation of Prosthesis: A Case Report
Journal of Orthopaedic Case Reports
author_facet Mantu Jain
Amar Jyoti Bihari
Amar Jyoti Bihari
author_sort Mantu Jain
title Ipsilateral Fracture Shaft Femur with Neglected Dislocation of Prosthesis: A Case Report
title_short Ipsilateral Fracture Shaft Femur with Neglected Dislocation of Prosthesis: A Case Report
title_full Ipsilateral Fracture Shaft Femur with Neglected Dislocation of Prosthesis: A Case Report
title_fullStr Ipsilateral Fracture Shaft Femur with Neglected Dislocation of Prosthesis: A Case Report
title_full_unstemmed Ipsilateral Fracture Shaft Femur with Neglected Dislocation of Prosthesis: A Case Report
title_sort ipsilateral fracture shaft femur with neglected dislocation of prosthesis: a case report
publisher Indian Orthopaedic Research Group
series Journal of Orthopaedic Case Reports
issn 2250-0685
publishDate 2013-10-01
description Introduction: Neglected hip dislocation is rare in today’s world and after prosthesis replacement even rarer finding. However such patients may not report to surgeons until they develop secondary complications. Management of such patient’s is a challenge to the treating surgeon and need to be tailored suiting to patient’s demands, expectations and constraints of financial resources. We did not find a similar case in the electronic and print media and therefore report this case which was innovatively managed. Case Report: A 60 year farmer presented with fracture shaft femur and ipsilateral dislocation prosthesis of right hip. He had a hemiarthroplasty done for fracture neck of femur in the past but used to walk with a lurch since he started to ambulate after discharge. However he was satisfied despite “some problems” which had caused shortening of his limb. The patient was informed of the various treatment options and their possible complications. He expressed his inability to afford a Total Hip Arthroplasty (THA) at any stage and consented for other options discussed with him. The patient was positioned supine and adductor tenotomy done. Next he was positioned laterally and the fracture was fixed with heavy duty broad dynamic compression plate and screws. The wound was temporarily closed. Now through the previous scar via posterior approach the hip was exposed. The prosthesis was found to be firmly fixed to the proximal femur. The acetabulum was cleared with fibrous tissue. All attempts the prosthesis to relocate the prosthesis failed after several attempts and it was best decided to leave alone. Post operatively period was uneventful. At follow up he refused for any further manoeuvre in future inform of heavy traction and attempts to reduce the same. At one year when he was walking unaided and his X-rays showed that fracture had well united his SF-36 score was PCS – 49.6 and MCS – 51.9. Conclusion: Ipsilateral shaft femur fracture in chronically dislocated prosthesis, done for fracture neck of femur is a rare clinical entity. Increased stress transfers due to dislocation compounded with osteoporosis makes the shaft vulnerable to fracture even with low velocity injury as in our case. Though fixation of fracture shaft femur is clear and straightforward; management of neglected prosthesis dislocation have to be guided by patient’s level of expectations and subjective contentment to adaptation to the altered hip state which influence the overall functional outcome. Keywords: Neglected dislocation, ipsilateral femoral fracture, hip arthroplasty.
url http://www.jocr.co.in/wp/2013/10/11/2250-0685-127-fulltext/
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