Surgical Discussion

A THA would be the treatment of choice in a patient of this age with a femoral neck fracture in the setting of OA, but of course we have this acetabular fracture to deal with- in some cases, acute ORIF + THA (stabilize the columns, get a stable and well fixed cup in), but not in this case. The posterior column is segmental with a free sciatic buttress, and the anterior column is definitely not going to be stable enough acutely to help. Also, some surgeons are staying from acute ORIF + THA when multiple approaches are required due to the risk of infection. So that leaves us with 2 options 1) fix them both and THA at 6-8 weeks or 2) just fix it and see how she does. A big part of this decision is how the patient was pre-injury. If they were miserable, a conversion would be a pretty easy answer. But as in this case, the patient was doing well enough that she really didn’t want a THA. She is now almost 6 months out, healed, ambulatory, and doing pretty well. She’s met with a joints surgeon and is going to continue to hold off on the hip for now. My biggest worry in this case was early failure of femoral neck fracture fixation. Because her hip is so still, there is a ton of stress concentration at the neck fracture. I was 50/50 on whether the screws work, and that’s why I went with the configuration (compress, then “lock in” with pauwels screw, and pray)