This document describes the treatment of a 20-year-old patient who sustained a fractured neck of the femur. The initial fixation failed, resulting in cut through of the implants, which were removed after 5 months. MRI confirmed viability of the femoral head. The plan was to fix a fibular graft to fill the previous DHS tract, re-fix with a DHS device, and perform an abduction osteotomy. However, during the procedure the DHS screw pushed too far inferiorly due to soft bone. Additional trochanteric wiring was required to avoid too much medialization from the high subtrochanteric osteotomy connecting to the barrel plate hole.

1. Fracture Neck femur in Young Adult
Dr. B. Shivashankar
President NAILS 2008-09
( National Association of Inter Locking Surgeons )
President Elect MOA
(Maharashtra Orthopaedic Association)
Iyer Ortho Centre
SOLAPUR, India

2. Photo Album of Fracture Neck
Femur
Young Adult of 20 years
Sustained Fracture Neck Femur in April 2012
First Fixation resulted in cut through
Implants were removed in May 2012
Presented after 5 months in September 2012

6. Current Pictures

8. MRI to confirm Vascularity / Viability of Head

11. Plan was to
fix fibula graft to fill the earlier DHS tract
Re Fix with DHS
To do Abduction Osteotomy
Problems faced
Fibula graft could be passed as per plan
But while passing DHS screw,
as the bone was very soft inferiorly and also
due to the fibular strut,
the screw got pushed too much
inferiorly inadvertently - position accepted .
Also the high sub trochanteric osteotomy got
Connected with the large hole of barrel plate.
So to avoid too much medialisation,
Additional trochanteric wiring was done

18. DISCLAIMER
• This presentation is prepared for dissipation of general
knowledge.
• All pictures have been taken by the author
• It is intended for use only by the students of orthopaedic
surgery. Views expressed in this presentation are personal.
• This should not be used in any court of law as evidence. This is
not the only way of treating these types of fractures, but one
of the way.
• For any confusion please contact the author for clarification.
• Every body is allowed to copy or download and use the
material best suited to him. And should give credit to the
author if used any where. There is no financial involvement.
• For any correction or suggestion please contact
<drbshivashankar@gmail.com>