Femoral Neck Fracture Associated
To Homolateral Cotyle Treated By Cemented Hip Total Arthroplasty
* Fawzi Boutayeb,
# Saïd Boujraf, ж
*Department of Orthopedic and Traumatic Surgery, University
Hospital Hassan II, Fez 30000, Morocco
#Department of Biophysics and Clinical MRI Methods, Faculty of
Medicine and Pharmacy, University of Fez, Fez 30000, Morocco
жDepartment of Orthopedic and Traumatic Surgery, University
Hospital Chieck Zayd, Rabat 10000, Morocco
Address for Correspondence
Prof. Fawzi Boutayeb,
Department of Orthopedic and Traumatic Surgery,
Al Ghassani Hospital, University Hospital Hassan II, Fez 30000;
Phone: 00 212 61 480 022, Fax: 00 212 55 941 364
The association of a femoral neck fracture
and a fracture of the acetabulum without hip dislocation is an
exceptional lesion. We report such lesion which was treated by a
total prothesis of cemented hip.
Key Words: Femoral Neck fracture, Acetabulum Fracture,
Hip dislocation Fracture, Total Hip Arthroplasty (THA)
The femoral neck
fracture associated to transversal cotyle without dislocation of
the hip is a rare lesion, but it has a severe gravity (1). It
involves the functional prognosis of the hip. In this paper, we
report such lesion which was treated by a total arthroplasty of
cemented hip, and we discuss the physiopathologic aspects as
well as the therapeutic attributes.
Material and Methods :
patient is male of sixty year old; he was admitted at the
department of traumatology and orthopedics surgery of the
University Hospital Hassan II in April 2004. He was transferred
from a regional hospital for treating a multiple fractures
following an accident that happened on the public road. The
radiography showed a comminuted epiphyseal fracture of the left
radius and a fracture of the right femoral neck Garden IV,
associated to a transverse acetabulum fracture without
of the left hip (Figure 1). The fracture of the wrist
embranchment was achieved 48 hours after hospitalization, this
was done under locoregional anesthesia. A traction-suspension
was set during four weeks of fractures of the hip. Then we
realized a total arthroplasty of hip cemented without any
difficulty (Figure 2). A recession of 18 months showed a patient
a good functional result.
The fracture of the femoral neck associated
to cotyle fracture without dislocation of the hip, is an
exceptional lesion. Only too few cases were reported in the
literature (1-5). Khalily et al reported a case of bilateral
pathologic fracture of the neck and ipsilateral acetabulum (6).
In contrast, an association of the femoral
neck fracture to dislocation fracture of the hip (fracture of
the posterior wall of acetabulum) is a not frequent lesion
(7-9). The dislocation is caused by an axial force of
compression combined with adduction (9). If the longitudinal
forces are stronger than the adduction forces, the acetabulum
fracture is yielded. Given that the head is fixed by the round
ligament and if adduction forces are important, a fracture of
the femoral neck is produced. Meller et al (10) considered that
there is an effect of “coup” and “contrecoup” in the production
of the femoral neck fracture. Klasen (7) reports two cases of
young patients which presented a posterior dislocation fracture
(acetabulum’s posterior wall) associated to a femoral neck
fracture; this was treated by double compressive screwing for
the fracture of the collar, and a screwing of the posterior
wall. The treatment of choice of the young subject consists of
an anatomical reduction of fractures and a stable synthesis
which are essential conditions for a good consolidation. The
total arthroplasty of hip will be suggested in secondarily terms
at the stage of post-traumatic degenerative osteoarthritis, this
approves any defect of reduction of the cotyle fracture, and
also after the femoral head necrosis. In the case of our
patient, regarding his age and his general state, we preferred
to implant at once a total prothesis of cemented hip. This was
for avoiding a substantial surgery of the both fractured lesions
and prolonged discharge; therefore allowing an immediate
The cotyle fracture associated to a fracture
of the homolateral femoral neck is an extremely rare lesion. An
anatomical reduction of both lesions with solid synthesis is the
logical attitude for obtaining the consolidation. Nevertheless,
the price is a surgery which is not always uncomplicated. The
total arthroplasty of hip is also a valid therapeutic option for
old subjects. It allows treating both, lesions and with an
immediate functional recovery.
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This is a peer reviewed paper
Please cite as
: Fawzi Boutayeb:Femoral Neck Fracture Associated To
Homolateral Cotyle Treated By Cemented Hip Total Arthroplasty
CME & Hands on
Basic Surgical Techniques
(6th Annual Conference of
sessions & Workshop
March 04, 2007
At Port City of Calicut, Kerala, India
Dept of Orthopaedics,
Medical College, Calicut, Kerala, India