Simultaneous Treatment of Neglected Femoral Neck and Subtrochanteric Fractures and a Secondary Femoral Shaft Fracture: A Case Report

同側延遲性股骨頸與轉子下骨折及續發性股骨幹骨折之手術治療：病理報告

楊南屏(Nan-Ping Yang) ； 魏寬毅(Kuan-Yih Wei) ； 張金堅(King-Jen Chang)

《Formosan Journal of Surgery》 37卷2期 (2004/04) Pp. 69-73

摘要

複雜性多處股骨骨折，臨床上並不常見。本文報告一例86歲女性，右側髖部延遲性股骨頸及股骨轉子下骨折併癒合不良，因長期臥床產生雙側髖關節及膝關節攣縮變形。病人一次因肺炎住院，翻身照護過程中再度產生同側股骨幹骨折，考慮到病人日後的長期照顧及改善其生活品質，因此安排手術以長柄之人工半髖關節及鋼纜、鋼板同時解決三處骨折。術後病人傷口發生感染現象，經過五星期的抗生素治療，感染情形獲得控制。追蹤三年半，病人骨癒合良好，穩定長期照護中。在此，我們報告這例罕見疾病，以及回顧相關文獻報告。

並列摘要

An iatrogenic femoral shaft fracture complicating neglected femoral neck and subtrochanteric fractures is rare. We report a case of an 86-year-old woman, admitted for pneumonia and sepsis, with simultaneous neglected femoral neck and subtrochanteric fractures of the right hip and flexed contracture of the hip and knee joints of both legs due to long term bed-rest. These were secondarily complicated by an iatrogenic ipsilateral femoral shaft fracture when the nursing staff attempted to change her position. Surgical intervention was performed for further care and quality of life: the neglected fractured femoral head was removed, and the malunion of 2 subtrochanteric fragments was separated by osteotomy; a long bipolar cementless stem was placed through these segments, and an external cable-plate system with proximal and distal cables was advanced laterally. An acute superficial methicillin-resistant Staphylococcus aureus infection occurred post-operatively and required a 5 week regimen of vancomycin. Finally, the infection was treated successfully. Bone union was evident radiographically 18 months after the surgery. Up to now, the patient has remained bedridden but pain-free for more than 3.5 years.

並列關鍵字

femoral neck fracture ； subtrochanteric frature ； femoral shaft fracture