Author | Sex/ Age | Mechanism | Fracture Configuration | Imaging | Difficulty in diagnosis | Associated injuries and comorbidities | Management | Follow up | Outcome and complications at final follow-up |
---|---|---|---|---|---|---|---|---|---|
An et al. 1989 [1] | 97M | Twisting fall | Four-part intertochanteric & subcapital fracture | Radiographs | Subcapital fracture on subsequent imaging whilst patient in traction awaiting medical optimisation | Arrythmia requiring cardioversion preoperatively | Long porous coated stem with a bipolar head hemiarthroplasty and cerclage wires. Bone grafting to medial cortex. | 8 months | Asymptomatic |
Pemberton et al. 1989 [2] | 73 F | Fell getting out of bed | Subcapital Garden IV & basal cervical fracture | Radiographs and isotope bone scan | Radioisotope bone scan to confirm acute nature of both fractures | Nil | Five hole DHS | 30 months | No problems relating to hip. No evidence of AVN on radiographs or isotope bone scan. |
Cohen & Rzetelny 1999 [3] | 79 F | Fall at home | Comminuted pertrochanteric & subcapital fracture | Rdiographs | Subcapital fracture noticed intraoperatively on fluoroscopic screening | Nil | Four hole DHS | 24 months | Painfree, mobilising with a stick |
Lawrence & Isaacs 1993 [4] | 72F | Run over by a car | Intertrochanteric & subcapital Garden II fracture | Radiographs and CT | Suspected subcapital fracture requiring CT scan for delineation | Contralateral pubic rami fractures, pulmonary contusions | Four hole DHS | 1 month | Satisfactory radiographs. Discharged to hospice at 2 months and died shortly afterwards of metastatic bowel carcinoma |
Kumar et al. 2001 [5] | 83 F | Slid down couch landing directly on hip | Comminuted intertrochanteric & subcapital Garden II fracture | Radiographs | Nil | Arryhthmia requiring correction preoperatively | Derotation screw, five hole DHS, and trochanteric grip plate | 12 months | FWB with no hip pain. Radiographs with satisfactory healing and minimal head collapse, Bone scan with evidence of AVN. |
Lakshmanan & Peehal 2005 [6] | 91 F | Fell from bed | Intracapsular fracture extending to the extracapsular lesser trochanter | Radiographs | Nil | Nil | Cemented hemiarthroplasty | 6 moths | Satisfactory clinically and radiographically |
Sayegh et al. 2005 [7] | 54 M | Crush injury in an olive press | Pertrochanteric and subcapital fracture with a nondisplaced greater trochanter | Radiographs | Nil | Extensive soft tissue injury to ipsilateral distal third femur and knee, and closed fracture to ipsilateral humerus | Open reduction and 5 hole DHS and cerclage wire | 58 months | 2cm shortening clinically, but satisfactory radiographs with union. |
Butt et al. 2007 [8] | 30 M | RTA | Intracapsular and & reverse oblique intertrochanteric fracture | Radiographs | Nil | Nil | DHS with derotation screw | 12 months | Pain free with no AVN |
Poulter & Ashworth 2007 [9] | 76 F | Not stated | Minimally displaced intertrochanteric & slightly angulated subcapital fracture | Radiographs | Nil | Nil | Percutaneous compression plate (two sliding screws in barrels with a plate) | 4 months | FWB, no pain, good ROM. Satisfactory radiographs at 3 months. |
Dhar et al. 2008 [10] | 30 M | RTA | Femoral neck and trochanteric reverse oblique fracture | Radiographs | Nil | Nil | Two intertrochanteric lag screws, a DCP, and two cannulated neck screws. | 12 months | Pain free with no AVN |
Perry & Scott 2008 [11] | 86 F | Fall at home | Displaced intertrochanteric & undisplaced intracapsular fracture | Radiographs | Intracapsular fracture missed on initial radiographs and only appreciated once displaced following DHS fixation and 10 weeks of mobilisation | Nil | Four hole DHS | 3 months | Fixation failed despite 4 weeks of protected weight bearing, but patient refused further surgery |
Loupasis et al. 2010 [12] | 36 M | Motorcyclist thrown after head on collision with car | Displaced intertrochanteric & subcapital Garden II fracture | Radiographs | Nil | Nil | Three hole DHS with a derotation screw | 24 months | Asymptomatic, resumed normal activities. Harris hip score 93.0. Radiographs satisfactory with no AVN. |
Neogi et al. 2011 [13] | 28 M | Front seat unrestrained passenger involved in RTA | Reverse oblique trochanteric and minimally displaced intracapsular fracture | Radiographs and CT | Intracapsular fracture only identified on CT scans performed for contralateral hip investigations | Contralateral posterior hip dislocation, posterior acetabular fracture and femoral shaft fracture. | DCS and derotation screw | 28 months | Good fuctional outcome with no AVN |
Tahir et al. 2014 [14] | 87 F | Fall at nursing home | Minimally displaced intertrochanteric and subcapital fracture | Radiographs and CT | Nil | Cardiac arrhythmias noticed on admission | Cemented bipolar hemiarthroplasty and trochanteric plate | 3 months | Postoperative wound discharge requiring vaccum dressing. At final follow-up, improving mobility and satisfactory radiographs. |