殿筋内脱臼股に生じた大腿骨転子下骨折の1例

Subtrochanteric Fracture with a Congenitally/Developmentally Dislocated Hip. Case Report

　殿筋内脱臼股に大腿骨転子下骨折が生じた症例を経験した．症例は87歳の女性で，尻もちをついて受傷した．X線像で左殿筋内脱臼股（Crowe分類groupⅣ）および転子下骨折がみられ，骨頭は消失，頚部は短縮，小転子は消失し，大腿骨近位部骨径が狭小化していた．脱臼を整復する人工股関節置換術も考えたが，全身状態および骨折前の活動度を考慮して観血的整復内固定術を行った．骨折形態からDCS plateを使用した内固定術を行った．術後4週で荷重を開始し，術後6週で全荷重を行い，術後3カ月で骨折前の歩行レベルが可能となった．

　An 87-year-old woman with a congenitally/developmentally dislocated hip suffered a subtrochanteric fracture of the ipsilateral femur. The left femoral head and lesser trochanter were absent. The left femoral neck was short and the proximal femoral shaft was narrow. The fracture was treated by open reduction and internal fixation with a 95-degree DCS plate. Partial weight bearing was started at 4 weeks and full weight bearing at 6 weeks, and the patient recovered her pre-fracture walking ability by 3 months after surgery. When total hip arthroplasty is performed on a patient with a dislocated hip, the acetabular component should be placed in the anatomical position and the femur should be shortened to prevent excessive limb lengthening or sciatic nerve injury. In view of the patient's age and cardiopulmonary status, however, we did not choose to perform that procedure. The patient's general condition, pre-fracture walking ability, hip joint configuration, and fracture pattern should be considered when treating a proximal femoral fracture with a congenitally/developmentally dislocated hip.