Fracture healing stages

I share with you a case of Intertrochanteric fractures of the femur that was fixed 6 years ago with DHS. She is 80 years old. Now we report severe osteoarthritis of the ipsilateral hip.

The patient presented with severe hip pain that increases with weight bearing and ipsilateral decrease in range of movement.

This severe osteoarthritis is not expected because this is contrary to the common belief of decreasing incidence of progression of osteoarthritis after Intertrochanteric fracture.

Figure 1, AP view of the pelvis show severe osteoarthritis of right hip and ankylosing. Dhs is properly placed. 

Discussion and review of literature 

Biyani et al retrospectively studied the radiographs of 255 patients with intertrochanteric fractures over a two year period. They found that the incidence of osteoarthritis of the hip joint in these patients was about 12%. That was less than the reported incidence in the general population which confirms the protective effect of osteoarthritis against intertrochanteric fractures. (1)

Robstad et al reported no differences on the injured side in the rate of hip OA between hip fracture cases and hip contusion cases. (2)

Hrubina et al, performed 367 DHS operations to treat 341 patients with proximal femoral fractures. They found that avascular necrosis of the femoral head occurred in 5 patients and progression of coxarthrosis occurred in 4 patients. (3)

Reference 

1- Biyani A, Simison AJ, Klenerman L. Intertrochanteric fractures of the femur and osteoarthritis of the ipsilateral hip. Acta Orthop Belg. 1995;61(2):83-91. PMID: 7597894.

2- Robstad B, Frihagen F, Nordsletten L. The rate of hip osteoarthritis in patients with proximal femoral fractures versus hip contusion. Osteoporosis International. 2012 Mar;23(3):901-5.

3- Hrubina M, Skotak M, Běhounek J. Complications of dynamic hip screw treatment for proximal femoral fractures. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 2010 Oct 1;77(5):395-401.