Challenging ipsilateral hip and segmental diaphyseal femur fractures with a severely osteoarthritic hip joint: lessons learnt.

To cite: Matar HE, ElHosh S, Attar FG. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015212593 DESCRIPTION Patients with hip fractures very rarely have hip osteoarthritis (OA), 2 with published data suggesting an inverse relationship between hip fractures and hip OA. In fact, hip OA is found to be protective against intracapsular fractures but increases the risk for extracapsular fractures. This is related, in part, to the restricted motion, especially rotation, abduction/adduction and flexion contractures of osteoarthritic hips, that alters the dissipation of mechanical forces generated by the fall. This leads, in turn, to increased joint reactive forces being transmitted through the femoral neck leading to increased bone density and the formation of buttressing of the medial femoral calcar. We present interesting images of a rare challenging intracapsular hip fracture and ipsilateral segmental diaphyseal femur fractures in an 82-year-old woman with severe bilateral hip OA. She suffered a fall following a right middle cerebral artery stroke with residual left hemiplaegia. Plain radiographs of the pelvis and left femur (figure 1) demonstrate the extent of her complex fractures. Following 2 weeks of medical management and optimisation, she was deemed fit for limited surgery for pain relief and to facilitate rehabilitation.