Management of An Additional Trochanteric Fracture on

Previously Femoral Shaft Fracture : An Atypical Case

Report

Harry Jonathan, INA

History & Pre-op X-ray Bonesetter ,
Lost of follow
up , 1 month
later

Male , 37 ,
MVA
Treated in Other Center

2 months
4 months..
Then it Happened
• Again MVA
• High Velocity
• Monotrauma

• 31 – A2
• Concurrent ipsilateral fractures of the shaft and proximal femur are rare , 1 % of femoral
fracture

• Haas, et al . 30 possible surgical treatment , with variety of treatment concepts have

been proposed

• Method of fixation
• Additional or Replacing
• Canal Deficiency
• Benefit for the patient
• Reduce operation time and blodd loss
• Early mobilization
Our Decision?
Follow up X-ray

4th month 6th month

• Duration of the operation are 60 minutes and the blood loss are are around
40 cc
• An Intra Operative image intensifier are beneficial
• Quadricep isometric exercise with passive movement of the hip and knee
• Crutch walking on his 4th day , and 10 kg Partial weight bearing on the 6th
week
• Assesment of the functional result was performed using Harris Hip Score
showing good result
Conclusion
• Combination between Proximal femoral nail and conservative Plate and screw is an
option to consider
• Shorter operation duration , lesser blood loss are the benefit
• A further biomechanic studies , longer follow up and bigger number of case are
needed for this kind of fixation
• Many fixation technique and combination comes with many invention of fixation
device in Orthopaedi ( An Art based on science)

• Select treatment for your patient as an individual

- Robert Bruce Salter-