![]() Antibiotic therapy with intravenous cefazolin and tetanus prophylaxis were started. The fracture was aligned under traction, and the wound was closed in planes. At the operating room, the fracture was mechanically cleaned with a thorough wound rinse. Wound inspection revealed bone fragments, confirming it as an open femoral neck fracture ( ► Figure 1]). ![]() ![]() A conventional radiographic study showed a comminuted, deviated fracture of the left femoral neck. The clinical examination also revealed pain and functional impairment at the ipsilateral knee, with joint instability suggesting a potential injury to the posterior cruciate ligament. Upon the physical examination, he reported severe hip pain and bleeding from a wound at the left gluteal region. At the initial clinical evaluation, the patient was conscious, breathing normally, with no chest or abdominal complaints, and no signs of hemodynamic instability. Case ReportĪ Caucasian, single, 35-year-old male patient was involved in a car accident, and sustained typical trauma due to impact on the dashboard, resulting in a comminuted fracture at the left femoral neck with proximal migration of the diaphyseal segment, extensive injury at the gluteal musculature, and bone exposure. When associated with a major trauma resulting in bone exposure and extensive injury to the soft tissue of the hip, this fracture becomes unique and difficult to solve. The pattern of the fracture pattern, the comminution in the focus of the fracture, and the degree of deviation of the fragments are associated with surgical complications, including lack of consolidation, osteosynthesis failure, and femoral head avascular necrosis. These fractures result from high-energy trauma, and damage the soft tissues. This therapeutic strategy (total hip arthroplasty with muscle transfer to reconstruct the abductor musculature) was successful to treat an intracapsular proximal femoral fracture with bone exposure.įractures, open - femur neck - adult - aged Introductionįemoral neck fractures in patients younger than 50 years of age account for less than 5% of all hip fractures. In addition, a radiographic study showed that the cemented total prosthesis was well-positioned. At 10 months of follow-up, the patient presented good functional outcome, with gradual recovery of the abductive strength and a Harris Hip Score of 91 points. We describe the initial treatment and subsequent management until achieving a definitive solution using total hip arthroplasty and muscle transfer to reconstruct the abductor mechanism of the hip. The proximal femur was exposed at the gluteal region due to a mechanism similar to dislocation of the posterior hip. In the present article, we describe a case of this injury in a 35-year-old man involved in a car accident. However, reports of open intracapsular proximal femoral fracture due to indirect trauma are rare in the orthopedic literature. ![]() In young patient, it is uncommon, usually caused by high-energy trauma and accompanied by damage to the adjacent soft tissues. Intracapsular proximal femoral fracture is a frequent injury in elderly patients, often associated with low-energy trauma and reduced bone mass. ![]()
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