Author(s): Basim Almaqtari, Ahmed Al-Ameri, Ibrahim Hatrom and Ghamdan Gamal Alkholidy

Abstract: Peritrochanteric fracture among adult are very rare among adults, which needs to be reduced fractures and fixed appropriately for optimum outcome. Comminuted unstable peritrochanteric fractures are challenging injuries that can cause many complications. The current study presented a novel technique for reduction and fixation using a proximal femur locking plate and augmented by long distal tibia medial locked plate, which was placed anteriorly. As we know there is a lack of scientific literatures studied this augmented method as primary method of fixation. A 25-year-old male patient was brought to the emergency department having left hip pain and he was unable to bear his body weight since 12 hours after sustaining a high velocity gunshot injury to his left hip. Physical examination revealed stable hemodynamically status. Upon local physical examination of his affected limb revealed external rotation deformity and shortening of the limb approximately 2cm than healthy contra-lateral limb as shown in figure no.(1). There were two penetrated wounds, the first wound was in anteromedial proximal thigh 3cm length * 2 cm width, second wound was 10cm length *3cm width in posterolateral proximal thig. Neurovascular examination was normal. Past medical history was irrelevant and no any medical comorbidities. Laboratory tests revealed WBC and CRP within normal range. Imaging including pelvic, hip and lower limb x-rays and CT- scan showed complex comminuted peritrochanteric femoral fracture with comminution of greater trochanters. Because of lack of precise classification grade for this pattern of fracture, we diagnosed the fracture “open complex comminuted peritrochanteric femur fracture”. Due to the instability and complexity of the fracture, several discussions were conducted to figure out what the best strategy available for definitive fixation. The preoperative plan was to remove the external fixator and perform the internal fixation at the same sitting using a proximal femur locking plate and augmented by anteriorly placed long distal tibia medial locking plate. Postoperative follow up period was uneventful. At eight months postoperatively, patient was able to walk without any walk assist such crutches and patient return to his preinjury condition. Peritrochanteric femur fracture is rare, specifically in young adult. The complex peritrochanteric fracture is challenging fracture pattern which may associated with high complications such as nonunion, delayed union, malunion and implant failure. The optimal surgical treatment is controversial. We consider that treatment of this kind of fracture with augmented locking implants allowed achieving satisfactory reduction with stable fixation that permitted patient’s early functional rehabilitation which were the main goal of management.

DOI: 10.22271/27078345.2023.v5.i1b.147

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