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Young Hip Salvage: Arthroplasty is not always the right solution

Motor vehicle trauma is one of the leading causes of disability in young adults across the planet specially in developing countries. 

In this case, a 28-year-old female patient was referred to our center after suffering a femoral neck and shaft fracture. Patient underwent surgical treatment a year prior at the referring institution, the femoral shaft fracture had healed but the neck one present with a nonunion.

 

Figure 1 – weight bearing x-ray shows the failed proximal fixation and varus collapse of the proximal femur, additionally a 2 cm shortening was also present in the affected side

 

 

Figure 2 – Deformity analyses utilizing PeekMed correctly identifies the need to perform a varus deformity correction.

Methods:

In these cases, hip preserving surgery is the preferred choice given the problems associated with multiple future revisions with a hip arthroplasty. A valgus producing osteotomy is planned using PeekMed®, this allows us to transform vertical sheer forces into compressive ones by pivoting the fracture site in relation to the weightbearing axis, additionally lengthening is also achieved correcting previous leg length discrepancy. 

 

Figure 3 – Photoshop was used to remove hardware to the extent thought possible thus facilitating pre-operative planning. A lateral closing wedge osteotomy with a base of 2cm is planned and definitive fixation with a 135 blade, this corrects the head neck shaft angle to 135º.

 

Intra-operatively the pre-operative plan was executed and fully achieved restoring the biomechanical factors that led to the previous failure. Hardware removal was not complete as only a lateral approach was utilized, an additional approach could further jeopardize the femoral blood supply and wasn’t deemed necessary.

 

Results:

Neck shaft angle was corrected to 135º and union was achieved at 6 months post-operatively. Leg length discrepancy was corrected and no avascular necrosis developed within 2 years of follow-up. 

Figure 5 – Final follow-up x-ray showing complete union and no signs of avascular necrosis.

 

Conclusion:

Difficult cases do not always have a straightforward solution but with extensive pre-operative planning success can be achieved as is demonstrated in this case.

Planning was always a part of our group’s credo and PeekMed® has been instrumental in the digital transformation of that process.



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