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J.Orthopaedics 2005;2(2)e4
Introduction
Two cases
are reported of traumatic simultaneous hip fractures with
intertrochanteric in the right side plus avulsion of the greater
trochanter in the left side.
KEY WORDS: Trochanteric hip Fractures. Elderly trochanter
avulsion fractures.
Case report
Case 1:
A 67 year-old woman was admitted to the Emergency of the
University Hospital of The Andes (Merida. Venezuela), after
falling in the seated position. She referred intense pain in the
right hip and the clinical signs of an intertrochanteric
fracture. The X rays of the pelvis (Fig.1) showed an
intertrochanteric fracture (Jensen III (8) of the right side and
an avulsion fracture of the greater trochanter in the left side
. Her past medical history revealed that she had suffered a
stroke at age 47, with minimal sequels to walk. At age 55 years,
she also had a malleolar fracture, and at age 60 years
Osteoporosis was diagnosed (not for DEXA) .It was treated for
several months with Calcitonin and calcium plus Vitamin D. The
patient underwent opened reduction and internal fixation with
angulated plate of 95° implants and was able to walk again.
Fig.1: 67 year-old woman the X rays
of the pelvis showed an intertrochanteric fracture (Jensen III)
of the right side and an avulsion fracture of the greater
trochanter in the left side(arrow).
Case 2:
A 69 year-old man was admitted to the Emergency Room of the
University Hospital of The Andes (Merida. Venezuela) after
falling seated from his same height. He complained of severe
pain at the level of the right coxofemoral joint. The clinical
examination showed a shortened and laterally rotated right lower
extremity. X Ray of the hips (Fig. 2) revealed intertrochanteric
fractures type (Jensen V (8) on the right side and avulsion of
the left greater trochanter . His past medical history was
relevant for TBC at age 19, heavy drinking and smoking with
chronic obstructive lung disease .There were no other comorbid
findings. He also underwent opened reduction and internal
fixation of his fracture with angulated plate of 95° implant. He
returned to normal life 45
days after surgery.
Fig. 2: 69 year-old man X Ray of the
hips revealed intertrochanteric fractures type (Jensen V) onthe
right side and avulsion of the left greater trochanter (arrow)
Discussion
Simultaneous and bilateral
fractures of the proximal femur are extremely rare events.
Twenty-eight cases were reported between 1938 and 1956 (11).
Most fractures involved the neck of the femur and only one
patient had an intertrochanteric fracture (11). Convulsions due
to shock therapy or pharmacological convulsive therapy were
responsible for all fractures. Twelve new additional cases were
reported between 1960-2001 (1-12). Only one of them had an
intertrochanteric fracture (2) and in one case alone the
fracture was due to trauma (7). Again, seizures were responsible
for 3 cases (11,12) and the remaining cases had “spontaneous
fractures” with underlying systemic illness(1,2,4-6,9,10) or
local pathology(3).One patient reported trauma as the mechanism
for the fracture(7). Neck fracture predominated and one patient
had an intertrochanteric localization (2). Therefore, the
available literature describes only two cases of bilateral
intertrochanteric fractures (2,11). It should be emphasized that
in contrast our patient’s two cases had different mechanism for
the trauma and underlying systemic illness. Our cases had as is
usually seeing in the common Primary Type of osteoporosis, low
energy trauma was the responsible mechanism for the fracture.
Finally the X Ray finding had been previously
described in only one patient (2).
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