Treatment of a femoral neck fracture in a patient with dwarfism: a case report.

Background: Femoral neck fractures in patients with pituitary dwarfism present significant surgical challenges due to anatomical variations, compromised bone quality, and limited therapeutic options. The management of such cases requires careful consideration of both the anatomical constraints of and the potential complications associated with various fixation methods.

Case Presentation: This report presents the case of a 30-year-old female with congenital pituitary dwarfism who sustained a subcapital femoral neck fracture following trauma. After suffering a workplace injury due to a fall, the patient experienced left hip pain, limited mobility, and difficulty walking. The patient presented with characteristic features of dwarfism, including diminutive stature (1.2 m), multiple skeletal abnormalities, and significant osteoporosis. X-ray and hierarchical phase-contrast tomography examinations of the left hip joint revealed a displaced subcapital femoral neck fracture with compromised bone quality and a notably narrow medullary cavity. Surgical treatment was subsequently performed on the patient. After the onset of combined spinal-epidural anesthesia, the patient was placed on a traction bed and closed reduction was attempted three times, all unsuccessfully. The direct anterior approach in the supine position was then chosen for open reduction of the left subcapital femoral neck fracture. After surgery, pain relief and treatment to prevent venous thrombosis were provided. A postoperative digital radiography examination of the left hip showed good alignment of the fracture fragments. Two weeks post-surgery, the stitches were removed and the patient was discharged.

Conclusions: This study aimed to fill the gap in the literature on the selection of internal fixation methods for femoral neck fractures in patients with pituitary dwarfism. Compared with the widespread use of three cannulated screws, the femoral neck system (FNS), a type of internal fixation device for treating femoral neck fractures, was chosen for internal fixation within the medullary cavity due to stenosis. This method avoided the need for multiple drillings with guide pins to ensure internal fixation. Although the procedure prolonged the surgery, it provided better stability and compression capability at the fracture site. The outcome showed that the FNS was a better choice for patients with a similar condition.