A straightforward trochanteric fracture causing ischemia of the foot: about a rare case

¹Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V (HMIMV), Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco

^&Corresponding author
Naoufal Elghoul, Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V (HMIMV), Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco

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A 70 years old male with a history of lower limb arterial calcification, who fell on the ground onto his right hip, causing severe pain, and total impotence functional. Because he lived far from the hospital, the patient has rested at home. Two days later, and given that the color of the foot got changed and the pain got worse, he was transferred to our emergency department. On admission (three days after trauma), the patient was conscious, with no pulmonary or hemodynamic distress. The physical examination found that the right hip was in external rotation with shortening limb and aspect of ischemia of the foot (A). The palpation and mobilization of the hip were painful. The neurovascular examination showed ischemia of the foot. The pelvic X-ray revealed a trochanteric fracture along with calcification of the femoral arterial (B), prompting the patient to undergo surgery. After anesthetic preparation, the patient was taken to the operating room, in which transtibial amputation was performed, followed by a gamma nail of the fracture using the fracture table with no traction. The post-operative care was uneventful. The patient was discharged on an anticoagulant, and non-weight bearing until cicatrization, after which, the weight-bearing was allowed. At the last follow up of six months, the patient did well with no pain no ischemia, and he could walking using an artificial transtibial prosthesis; currently, he is followed in vascular surgery.

Figure 1: A) clinical aspect of the external rotation, and the ischemia of the foot; B) pelvic X-ray showed simple trochanteric fracture (yellow arrow) along with calcification of the femoral pedicle (black arrows)