Vinod NaneriaConsultant, Orthopaedics

Choithram Hospital & Research CentreIndore, MP, India

Comedy of Errors

Case Summary A 75 years old female Occasional pain right hip X-ray Hip showing incomplete trans-

cervical fracture neck of femur.

Plain X-ray

Incomplete fracture neck of femur

Normal serum chemistry

Three Knowles pins for prophylactic fixation

Mobilization with walker started

Developed sub-trochanteric extension following loss of balance

Fixation by DHS after reduction and stabilization by one inter-fragmentary screws

Plate bending started

Pain persisted

Ambulation continued

Pain persisted

Ambulation continued

Hoping union

Plate failed

Severe pain

Difficulty in ambulation

Reconstruction nailing

Moral of the story & lessons learned Never leave an empty hole in cortical

bone. Avoid making entry point below the level of

lesser trochanter for multiple pinning. Do not rely on inter-fragmentary screws in

sub-trochanteric fracture. Do not wait for plate to brake once failure is

evident.

DISCLAIMER• Information contained and transmitted by this presentation is based on personal experience and collection of cases at Choithram Hospital & Research centre, Indore, India, during last 25 years.

• It is intended for use only by the students of orthopaedic surgery. Many GIF files are taken from Internet.

• Views and opinion expressed in this presentation are personal opinion.

• Depending upon the x-rays and clinical presentations viewers can make their own opinion.

• For any confusion please contact the sole author for clarification. Every body is allowed to copy or download and use the material best suited to him. I am not responsible for any controversies arise out of this presentation.• For any correction or suggestion please contact naneria@yahoo.com