Abstract:

Hip fractures are common in elderly patients and are associated with significant morbidity and mortality, often referred to as the "last fracture of life". These fractures frequently result in a loss of functional independence. Evidence suggests that early surgical intervention can reduce mortality. The selection of treatment modality should take into account factors such as the type of fracture, the patient' s age, and overall health status. This case report discusses an 88-year-old female patient who sustained an unstable intertrochanteric fracture of the left femur following a fall. She underwent closed reduction and internal fixation using an InterTAN intramedullary nail, resulting in a satisfactory postoperative recovery. Sixteen months following the surgical procedure, the patient presented with progressive pain in the left hip and ambulatory difficulties, absent from any evident trauma. Radiographic analysis identified a fracture of the left femoral neck accompanied by some degree of acetabular bone degradation attributable to the implant. Subsequently, the patient underwent removal of the internal fixation device and received a hemiarthroplasty. The postoperative course was uneventful, with marked improvements in both pain levels and functional capacity. This case underscored the intricate nature of femoral neck fractures following the internal fixation of intertrochanteric fractures. Contributing factors may include advanced age, osteoporosis, and stress shielding induced by the implant. In patients presenting with hip pain or gait disturbances months to years post-intertrochanteric fracture surgery, the potential for a new fracture should be consi- dered, even in the absence of an explicit traumatic incident. Radiographic imaging is imperative to exclude the presence of a fracture, particularly in individuals with high-risk factors such as advanced age, osteoporosis, alcohol abuse, and a history of hormone therapy. Management of such cases may necessitate the removal of internal fixation devices and the implementation of hemiarthroplasty or total hip arthroplasty, contingent upon the patient ' s surgical tolerance. Crucially, anti-osteoporosis therapy serves as a vital preventive strategy. Considering the high-risk profile of elderly patients with hip fractures, diligent follow-up and timely intervention are paramount to mitigating complications and mortality, thereby enhancing the quality of life for these patients. This case highlights the critical need for increased vigilance and comprehensive management of elderly patients with hip fractures to enhance treatment outcomes and improve prognosis.

Key words: Hip fracture, Intertrochanteric fracture, Femoral neck fracture