PMC7276629_01
Pre-operative X-ray and magnetic resonance imaging (subcapital neck of femur fracture is seen in the right femur).
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F1
X-rays showed increased sclerosis and lyticlesions in both hips, suggestive of ONFH. X-ray was done after patient had inability to walk, which revealed increased sclerosis with decreased joint space, loss of contour with subcapital femoral neck fracture(Fig. 1).Magnetic resonance imaging (MRI) pelvis with both hips revealed osteonecrosis involving both heads and pathological subcapital fracture on the right side.(Fig. 2) Presentation of ONFH with subcapital fracture has not been included in the commonly used classifications.
Pre-operative magnetic resonance imaging (subcapital neck of femur fracture is seen in the right femur).
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F2
X-rays showed increased sclerosis and lyticlesions in both hips, suggestive of ONFH. X-ray was done after patient had inability to walk, which revealed increased sclerosis with decreased joint space, loss of contour with subcapital femoral neck fracture(Fig. 1).Magnetic resonance imaging (MRI) pelvis with both hips revealed osteonecrosis involving both heads and pathological subcapital fracture on the right side.(Fig. 2) Presentation of ONFH with subcapital fracture has not been included in the commonly used classifications.
Intraoperative images. (a) White arrow showing fracture fragment before hip dislocation.(b)Fracture site with blue color line and Allis forceps inserted in fracture site. (c)Final image after total hip arthroplasty.
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F3
Our intraoperative findings revealed that margins of the fracture were irregular with no capacity to bleed(Fig. 3).Cemented THA was done.
Description - histopathology showing viable trabecular bone with spicules of necrosed acellular bone.
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F4
Gross necrosis in the marrow and lipid infiltration was reported in histopathology of the femoral head which is consistent with osteonecrosis (Fig. 4).
Post-operative X-ray showing bilateral cemented total hip arthroplasty done.
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F5
The other hip was operated for cemented THA after 2 weeks (Fig. 5).