3 years ago

Fratura bilateral do colo do fêmur secundária a crise convulsiva: tratamento com artroplastia total do quadril pelo acesso anterior direto

Osamu De Sandes Kimura, Rui Felipe Pache De Moraes, Marco Bernardo Cury Fernandes, Emílio Henrique Carvalho Freitas, Alexandre Seabra, George Kalif Lima

Publication date: Available online 7 March 2018

Source: Revista Brasileira de Ortopedia

Author(s): Osamu de Sandes Kimura, Rui Felipe Pache de Moraes, Marco Bernardo Cury Fernandes, Emílio Henrique Carvalho Freitas, Alexandre Seabra, George Kalif Lima

Resumo

A fratura bilateral do colo do fêmur secundária à crise convulsiva é um evento raro. A ocorrência dessas lesões está relacionada a contrações musculares tônico‐clônicas vigorosas e ao uso de medicações anticonvulsivantes. As fraturas do colo do fêmur no adulto jovem tratadas com artroplastia total do quadril são exceção e a escolha do acesso cirúrgico deve levar em consideração diversos fatores, o acesso anterior direto é uma possibilidade para artroplastia total do quadril. Os autores apresentam um caso de um homem de 36 anos com fratura bilateral do colo do fêmur secundária a crise convulsiva e em uso regular de fenitoína. Devido ao risco de falha da fixação e ao tempo de evolução prolongado, optou‐se pela artroplastia total do quadril bilateral. A escolha da via de acesso deve levar em consideração a anatomia do paciente, a disponibilidade de materiais e a experiência do cirurgião. Dessa forma, a maior facilidade de preparo e posicionamento do paciente, o menor tempo de internação, a reabilitação pós‐operatória precoce e o domínio da técnica pelo cirurgião são possíveis justificativas para a adoção do acesso anterior direto.

Abstract

Bilateral fracture of the femoral neck secondary to seizure is a rare event. The occurrence of these lesions is related to vigorous tonic‐clonic muscular contractions and to the use of anticonvulsive medications. Femoral neck fractures in young adults treated with total hip arthroplasty are the exception and the choice of surgical access should take into account several factors; the direct anterior approach is a possibility for total hip arthroplasty.The authors present a case of a 36‐year‐old male with bilateral fracture of the femoral neck secondary to seizure and in regular use of phenytoin. Due to the risk of fixation failure and prolonged evolution time, bilateral total hip arthroplasty was chosen. The choice of the approach should take into consideration the patient's anatomy, material availability, and surgeon's experience. Thus, the greater ease of preparation and positioning of the patient, the shorter hospital stay, the early postoperative rehabilitation, and the mastery of the technique by the surgeon are possible justifications for the adoption of direct anterior approach.

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