Abstract
Intracapsular proximal femoral fracture is a frequent injury in elderly patients,
often associated with low-energy trauma and reduced bone mass. In young patient, it
is uncommon, usually caused by high-energy trauma and accompanied by damage to the
adjacent soft tissues. However, reports of open intracapsular proximal femoral fracture
due to indirect trauma are rare in the orthopedic literature. In the present article,
we describe a case of this injury in a 35-year-old man involved in a car accident.
The proximal femur was exposed at the gluteal region due to a mechanism similar to
dislocation of the posterior hip. We describe the initial treatment and subsequent
management until achieving a definitive solution using total hip arthroplasty and
muscle transfer to reconstruct the abductor mechanism of the hip. At 10 months of
follow-up, the patient presented good functional outcome, with gradual recovery of
the abductive strength and a Harris Hip Score of 91 points. In addition, a radiographic
study showed that the cemented total prosthesis was well-positioned. This therapeutic
strategy (total hip arthroplasty with muscle transfer to reconstruct the abductor
musculature) was successful to treat an intracapsular proximal femoral fracture with
bone exposure.
Keywords
fractures, open - femur neck - adult - aged
