PMC5485275_01
Preoperative images of the hip. (a) Radiograph of the anteroposterior (AP) view. (b-d) 3D-CT: (b) AP, (c) lateral, and (d) posterior-anterior (PA) views of the hip. Proximal femoral fracture in arthrodesed hip. Fracture line extends to pelvis. (e) Intraoperative image by intensifier. Instability of fracture site was confirmed and the displacement was increased with hip adduction.
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The fracture line started from the ilium, involving the original femoral head, and ended at the basicervical part of the femoral neck (Figures 1(a)-1(e)). Displacement was increased with passive hip adduction, and obvious instability was confirmed (Figure 1(b)).
Single incision approach was useful for reduction and fixation. (a) Anteromedial plate was positioned, retracting gluteus medius posteriorly. (b) Posterior plate was positioned, retracting gluteus medius anteriorly.
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The posterior part of fracture line was then similarly exposed by retracting the gluteus medius anteriorly (Figures 2(a) and 2(b)).
Postoperative images of the hip radiograph and 3D-CT of hip. (a) Radiograph of AP view. (b-d) 3D-CT: (b) AP, (c) lateral, and (d) PA views of the hip. Double-plate fixation positioned at the anteromedial and posterior aspects of the fracture site.
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Distal screws were inserted to the original femoral head through the fracture line (Figure 3). Appropriate reduction and rigid fixation were confirmed under the image intensifier (Figures 3(a)-3(d)).
Follow-up radiographs at 10 months after surgery. (a) AP view and (b) lateral view. Bone union of fracture site was revealed with no displacement and no implant complication.
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In the follow-up 10 months after surgery, radiographs and CT revealed bone union without fracture site displacement and no implant complication (Figures 4(a) and 4(b)).