A combined intracapsular and extracapsular fracture of the hip

We report a case of an unusual hip fracture that involved the intracapsular area and continued vertically to the extracapsular region below the trochanteric line. The division between these two types of fractures is based on the anatomical site, the blood supply and the mechanical forces that act on the hip. This division is important and influences the different surgical techniques to treat these individual fractures. Femoral neck fractures (intracapsular), particularly those with displacement, can disrupt the blood supply to the femoral head and may be associated with an increased incidence of complications, especially non-union and avascular necrosis (AVN) of the femoral head. These fractures are usually treated either by reduction and fixation, or by hemiarthroplasty. Non-union and avascular necrosis following extracapsular fractures are rare. Treatment involves reduction of the fracture and insertion of a dynamic hip screw. The combination of these two types of fractures is extremely rare and creates a surgical problem without any optimal solution. The focus of this case report is placed on the mechanical axis and weight-bearing forces that play a role in the hip and on the optional surgical techniques in such a rare type of fracture in an elderly osteoporotic patient.