Successful treatment of concomitant ipsilateral intracapsular and extracapsular hip fractures

Femoral neck fractures and intertrochanteric fractures often occur in elderly patients, but simultaneous ipsilateral intra- and extracapsular hip fractures are rare. Either osteosynthesis or femoral head prosthesis is performed, but careful rehabilitation is necessary because of the instability of the fracture, even postoperatively. This article describes a 76-year-old man who fell and sustained concomitant ipsilateral intra- and extracapsular hip fractures. The patient was treated with a femoral head prosthesis with a polished cemented stem combined with locking plate osteosynthesis. Weight-bearing gait was possible 1 day postoperatively, and bone union was achieved at postoperative week 8. The locking plate had excellent angular stability, even when the screw fixation was monocortical, leading to a reduced risk of intraoperative redislocation without disturbing stem insertion. Sufficient fixation was obtained as a result of the molding effect of the cement stem and the tension band function of the plate. These effects collectively made it possible to achieve full weight-bearing gait immediately postoperatively. Although the intramedullary blood circulation was disturbed by the cement, periosteal blood circulation was retained by the virtue of the locking plate, which facilitated early bone union.