Intertrochanteric Fracture in a Long-term Ankylosed Hip: A Case Report.

INTRODUCTION: The main objectives in the treatment of an intertrochanteric fracture in elderly population are to prevent medical complications, maintain mobility, independence, and relieve pain. When this fracture occurs in an arthrodesed hip, there is a significant lack of scientific evidence of optimal treatment and clinical results since only few case reports have been published so far. CASE REPORT: A Caucasian 83-year-old woman slipped and fell, complaining of the left hip pain. After radiographic evaluation, she was diagnosed with an intertrochanteric fracture that occurred in a long-term arthrodesed hip. We treated this rare presentation by open reduction and internal fixation with a proximal locking femoral plate and a pelvic reconstruction plate. No immobilization was needed in the post-operative care. Fracture healing occurred after 3months. CONCLUSION: Without motion on the hip, the lower extremity forms one long lever arm, creating an unusual instability at the fracture site. The authors decided that, to overcome this situation, the construction had to be reinforced and extended from the iliac wing to the proximal femur with two plates. This provided enough strength and stability to allow an uneventful fracture healing. This approach can be easily reproduced and can be considered in future similar patients.

Shoulder giant schwannoma - a diagnosis to be considered in painless shoulder masses.

Tumours formed from peripheral nerve sheaths are rare in the shoulder. We present the case of a 80-year-old female referred to an orthopaedic surgery clinic because of a large painless mass of the right shoulder, with one year of evolution. There was no history of trauma, involvement of any other joint or systemic complaints. Given the clinical and imagiological suspicion of a giant synovial cyst, the patient underwent complete surgical resection of the mass, which took place without any complications or functional impairment. Histological diagnosis - schwannoma - was unexpected given the lesion characteristics and the low incidence of these benign tumours. They usually present as a slow growth mass, where pain and neurological deficits are uncommon. Among the complementary tests available, MRI is the gold standard. Still, the diagnosis is made preoperatively only in a minority of cases. We emphasize the need to consider this rare clinical entity in the differential diagnosis of slow evolution tumourations of the shoulder, in order to avoid unnecessary surgery and to minimize the risk of iatrogenic injury of the involved nerve.