pirogovestnikВестник Национального медико-хирургического центра им. Н.И. ПироговаBulletin of Pirogov National Medical & Surgical Center2072-82552782-3628Национальный медико-хирургический Центр им. Н.И. Пирогова10.25881/20728255_2026_21_1_163pirogovestnik-553Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCASE REPORTSПЕРИИМПЛАНТНЫЙ ПОДВЕРТЕЛЬНЫЙ ПЕРЕЛОМ БЕДРЕННОЙ КОСТИ ПОСЛЕ ОСТЕОСИНТЕЗА ШЕЙКИ БЕДРЕННОЙ КОСТИ МЕТОДОМ ДВУХОПОРНОЙ ДВУХПОЛЮСНОЙ ФИКСАЦИИPERIPROSTHETIC SUBTROCHANTERIC FEMORAL FRACTURE FOLLOWING OSTEOSYNTHESIS OF FEMORAL NECK FRACTURE USING BIPLANE DOUBLE-SUPPORTED SCREW FIXATIONНазаровД. С.NazarovD. S.

Москва

Moscow

dilovarnazarov95@mail.ruАйрапетовГ. А.AjrapetovG. A.

Москва

Moscow

ЗагороднийН. В.ZagorodnijN. V.

Москва

Moscow

МироновА. Н.MironovA. N.

Москва

Moscow

КарповичН. И.KarpovichN. I.

Москва

Moscow

ЛукинМ. П.LukinM. P.

Москва

Moscow

БурковД. В.BurkovD. V.

Москва

Moscow

ДжоджуаА. В.DzhodzhuaA. V.

Москва

Moscow

ФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы»РоссияPeoples’ Friendship University of Russia named after Patrice LumumbaRussian FederationФГАОУ ВО «Российский университет дружбы народов им. Патриса Лумумбы»; ФГБУ «НМИЦ ТО им. Н.Н. Приорова»РоссияPeoples’ Friendship University of Russia named after Patrice Lumumba; Research Center for Traumatology and Orthopedics named after N.N. PriorovRussian FederationГКБ № 31 им. акад. Г.М. СавельевойРоссияCity Clinical Hospital No. 31 named after Academician G.M. SavelyevaRussian FederationФГБУ «Национальный медико-хирургический Центр им. Н.И. Пирогова»РоссияPirogov National Medical and Surgical CenterRussian Federation202621032026211163165Copyright © Назаров Д.С., Айрапетов Г.А., Загородний Н.В., Миронов А.Н., Карпович Н.И., Лукин М.П., Бурков Д.В., Джоджуа А.В., 20262026Назаров Д.С., Айрапетов Г.А., Загородний Н.В., Миронов А.Н., Карпович Н.И., Лукин М.П., Бурков Д.В., Джоджуа А.В.Nazarov D.S., Ajrapetov G.A., Zagorodnij N.V., Mironov A.N., Karpovich N.I., Lukin M.P., Burkov D.V., Dzhodzhua A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://submit.pirogov-vestnik.ru/jour/article/view/553Актуальность

Актуальность. На фоне глобального старения населения отмечается значительный рост частоты переломов шейки бедренной кости (ШБК) у пожилых. Несмотря на широкое применение канюлированных винтов, частота осложнений достигает 46%, что стимулирует поиск альтернативных методик, таких как метод двухопороной двухполюсной фиксации (ДДФ).

Цель

Цель. Представить осложнение в результате остеосинтеза шейки бедренной кости – периимплантный подвертельный перелом – и проанализировать его причины.

Материал и методы

Материал и методы. Описано клиническое наблюдение пациентки 64 лет с переломом ШБК Garden II, осложнившимся периимплантным переломом через 1,5 месяца после БДОФ. Проанализированы данные когорты из 31 пациента, оперированного методом БДОФ за период 09.2021–12.2024 в ГКБ №31.

Результаты

Результаты. В 3,2% случаев (n = 1) зафиксирован периимплантный подвертельный перелом. Ревизионный остеосинтез выполнен интрамедуллярным штифтом с положительным исходом.

Заключение

Заключение. Данный случай подчеркивает необходимость неукоснительного соблюдения биомеханических принципов ДДФ и разработки направляющего устройства для установки дистальных винтов, что позволит минимизировать риск повторных периимплантных переломов бедренной кости.

Background

Background. Global population aging has led to a significant increase in femoral neck fractures (FNF) among elderly patients. Despite the widespread use of cannulated screws, complication rates reach 46%, prompting the search for alternative techniques such as Biplanar Double-Supported Fixation (BDSF).

Objective

Objective. To present a rare complication of BDSF – periprosthetic subtrochanteric fracture – and analyze its etiological factors.

Materials and Methods

Materials and Methods. We describe a clinical case of a 64-year-old female with Garden type II FNF complicated by a periprosthetic fracture 1.5 months after BDSF. Data from a cohort of 31 patients who underwent BDSF between September 2021 and December 2024 at City Clinical Hospital No. 31 were analyzed.

Results

Results. Periprosthetic subtrochanteric fracture occurred in 3.2% of cases (n=1). Revision osteosynthesis with an intramedullary nail resulted in a successful outcome.

Conclusion

Conclusion. This case highlights the necessity of strict adherence to the biomechanical principles of BDSF (Biplane Double-Supported Fixation) and the development of a guiding device for distal screw insertion, which would minimize the risk of repeat peri-implant femoral fractures.

перелом шейки бедрабипланарная двухопорная фиксацияпериимплантный переломостеосинтезосложненияFemoral neck fractureBiplane Double-Supported Fixation (BDSF)Periprosthetic fractureOsteosynthesisComplicationsReferencesGjertsen J-E, Vinje T, Engesæter LB, Lie SA, et al. Internal Screw Fixation Compared with Bipolar Hemiarthroplasty for Treatment of Displaced Femoral Neck Fractures in Elderly Patients. The Journal of Bone & Joint Surgery. 2010; 92(3): 619-628. doi: 10.2106/JBJS.H.01750.Gjertsen J-E, Vinje T, Engesæter LB, Lie SA, et al. Internal Screw Fixation Compared with Bipolar Hemiarthroplasty for Treatment of Displaced Femoral Neck Fractures in Elderly Patients. The Journal of Bone & Joint Surgery. 2010; 92(3): 619-628. doi: 10.2106/JBJS.H.01750.Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: A meta-analysis of 14 randomized studies with 2,289 patients. Acta Orthopaedica. 2006; 77(3): 359-367. doi:10.1080/17453670610046262.Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: A meta-analysis of 14 randomized studies with 2,289 patients. Acta Orthopaedica. 2006; 77(3): 359-367. doi:10.1080/17453670610046262.Davison JN, Calder SJ, Anderson GH, et al. Treatment for displaced intracapsular fracture of the proximal femur. A prospective, randomised trial in patients aged 65 to 79 years. The Journal of bone and joint surgery British volume. 2001; 83: 206-212.Davison JN, Calder SJ, Anderson GH, et al. Treatment for displaced intracapsular fracture of the proximal femur. A prospective, randomised trial in patients aged 65 to 79 years. The Journal of bone and joint surgery British volume. 2001; 83: 206-212.Li N, Cheng KY, Fan J, et al. Evaluating three internal fixation techniques for Pauwels III femoral neck fractures via finite element analysis. Sci Rep. 2024; 14: 15519. doi: 10.1038/s41598-024-66638-1.Li N, Cheng KY, Fan J, et al. Evaluating three internal fixation techniques for Pauwels III femoral neck fractures via finite element analysis. Sci Rep. 2024; 14: 15519. doi: 10.1038/s41598-024-66638-1.Ямщиков О.Н., Емельянов С.А., Беляев А.А., Чумаков Р.В. Опыт применения малоинвазивного перкутанного остеосинтеза при переломах проксимального отдела бедра // Вестник медицинского института «РЕАВИЗ». Реабилитация, Врач и Здоровье.–2024.–№14(2).–С.73-78. doi: 10.20340/vmi-rvz.2024.2.CLIN.9.YAmshchikov ON, Emel’yanov SA, Belyaev AA, CHumakov RV. Opyt primeneniya maloinvazivnogo perkutannogo osteosinteza pri perelomah proksimal’nogo otdela bedra. Vestnik medicinskogo instituta «REAVIZ». Reabilitaciya, Vrach i Zdorov’e. 2024; 14(2): 73-78. (In Russ.) doi: 10.20340/vmi-rvz.2024.2.CLIN.9.Filipov OB. Biplane Double-supported Screw Fixation of Femoral Neck Fractures: Surgical Technique and Surgical Notes. Journal of the American Academy of Orthopaedic Surgeons. 2019; 27(11): e507-e515. doi: 10.5435/jAAOS-D-17-00117.Filipov OB. Biplane Double-supported Screw Fixation of Femoral Neck Fractures: Surgical Technique and Surgical Notes. Journal of the American Academy of Orthopaedic Surgeons. 2019; 27(11): e507-e515. doi: 10.5435/jAAOS-D-17-00117.Xia Y, Zhang W, Hu H, Yan L, Zhan S, Wang J. Biomechanical study of two alternative methods for the treatment of vertical femoral neck fractures–A finite element analysis. Comput Methods Programs Biomed. 2021; 211: 106409. doi: 10.1016/j.cmpb.2021.106409.Xia Y, Zhang W, Hu H, Yan L, Zhan S, Wang J. Biomechanical study of two alternative methods for the treatment of vertical femoral neck fractures–A finite element analysis. Comput Methods Programs Biomed. 2021; 211: 106409. doi: 10.1016/j.cmpb.2021.106409.Jilani LZ, Abbas MB, Shaan ZH, Ahmad S, Abbas M. Outcomes of BDSF technique for osteosynthesis of femoral neck fractures. Int J Burns Trauma. 2023; 13(3): 149-155.Jilani LZ, Abbas MB, Shaan ZH, Ahmad S, Abbas M. Outcomes of BDSF technique for osteosynthesis of femoral neck fractures. Int J Burns Trauma. 2023; 13(3): 149-155.Singh ChI, Gonmei L, Sharma ChB, Singh SB. Evaluation of Biplane Double Supported Screw Fixation of Femoral Neck Fracture: A Longitudinal Study at a Tertiary Health Care Center in Manipur. Trends in Medical Research, 202116(2), 48–54. doi: 10.3923.Singh ChI, Gonmei L, Sharma ChB, Singh SB. Evaluation of Biplane Double Supported Screw Fixation of Femoral Neck Fracture: A Longitudinal Study at a Tertiary Health Care Center in Manipur. Trends in Medical Research, 202116(2), 48–54. doi: 10.3923.Galal S, Nagy M. Non-parallel screw fixation for femoral neck fractures in young adults. J Clin Orthop Trauma. 2017; 8(3): 220-224. doi: 10.1016/j.jcot.2017.07.003.Galal S, Nagy M. Non-parallel screw fixation for femoral neck fractures in young adults. J Clin Orthop Trauma. 2017; 8(3): 220-224. doi: 10.1016/j.jcot.2017.07.003.Kruse M, Mohammed J, Sayed-Noor A, et al. Peri-implant femoral fractures in hip fracture patients treated with osteosynthesis: a retrospective cohort study of 1965 patients. Eur J Trauma Emerg Surg. 2022; 48: 293-8. doi: 10.1007/s00068-020-01596-7.Kruse M, Mohammed J, Sayed-Noor A, et al. Peri-implant femoral fractures in hip fracture patients treated with osteosynthesis: a retrospective cohort study of 1965 patients. Eur J Trauma Emerg Surg. 2022; 48: 293-8. doi: 10.1007/s00068-020-01596-7.Halonen LM, Stenroos A, Vasara H, Kosola J. Peri-implant fracture: a rare complication after intramedullary fixation of trochanteric femoral fracture. Arch Orthop Trauma Surg. 2022; 142: 3715-20. doi: 10.1007/s00402-021-04193-4.Halonen LM, Stenroos A, Vasara H, Kosola J. Peri-implant fracture: a rare complication after intramedullary fixation of trochanteric femoral fracture. Arch Orthop Trauma Surg. 2022; 142: 3715-20. doi: 10.1007/s00402-021-04193-4.Park K-C, Lim S-J, Song YS, Hwang K-T. Factors affecting peri-implant fracture following locking plate for osteoporotic distal femur fractures. Orthop Traumatol Surg Res. 2017; 103: 1201-4. doi: 10.1016/j.otsr.2017.08.008.Park K-C, Lim S-J, Song YS, Hwang K-T. Factors affecting peri-implant fracture following locking plate for osteoporotic distal femur fractures. Orthop Traumatol Surg Res. 2017; 103: 1201-4. doi: 10.1016/j.otsr.2017.08.008.Müller F, Galler M, Zellner M, Bäuml C, et al. Peri-implant femoral fractures: the risk is more than three times higher within PFN compared with DHS. Injury. 2016; 47: 2189-94. doi: 10.1016/j.injury.2016.04.042.Müller F, Galler M, Zellner M, Bäuml C, et al. Peri-implant femoral fractures: the risk is more than three times higher within PFN compared with DHS. Injury. 2016; 47: 2189-94. doi: 10.1016/j.injury.2016.04.042.Cacciola G, Mancino F, De Meo F, Bruschetta A, et al. Current Reconstruction Options in Periprosthetic Fractures Around the Knee. Geriatric Orthopaedic Surgery & Rehabilitation. 2021; 12. doi: 10.1177/21514593211023996.Cacciola G, Mancino F, De Meo F, Bruschetta A, et al. Current Reconstruction Options in Periprosthetic Fractures Around the Knee. Geriatric Orthopaedic Surgery & Rehabilitation. 2021; 12. doi: 10.1177/21514593211023996.Ballhause TM, Gessler R, Priemel MH, Frosch K-H, et al. Osteosynthesis of a Multifragment Femoral Shaft Fracture and Peri-Implant Refracture in an 83-Year-Old Patient with Osteogenesis Imperfecta, Case Reports in Orthopedics. 2020; 8887644: 7. doi: 10.1155/2020/8887644.Ballhause TM, Gessler R, Priemel MH, Frosch K-H, et al. Osteosynthesis of a Multifragment Femoral Shaft Fracture and Peri-Implant Refracture in an 83-Year-Old Patient with Osteogenesis Imperfecta, Case Reports in Orthopedics. 2020; 8887644: 7. doi: 10.1155/2020/8887644.Teng L, Xiao Y, Zhong G. Zhongguo Xiufu Chongjian Waike Zazhi. Chinese Journal of Reparative and Reconstructive Surgery. 2021; 35(3): 312-317. doi: 10.7507/1002-1892.202010011.Teng L, Xiao Y, Zhong G. Zhongguo Xiufu Chongjian Waike Zazhi. Chinese Journal of Reparative and Reconstructive Surgery. 2021; 35(3): 312-317. doi: 10.7507/1002-1892.202010011.Halonen LM, Stenroos A, Vasara H, et al. Peri-implant fracture: a rare complication after intramedullary fixation of trochanteric femoral fracture. Arch Orthop Trauma Surg. 2022; 142: 3715-3720. doi: 10.1007/s00402-021-04193-4.Halonen LM, Stenroos A, Vasara H, et al. Peri-implant fracture: a rare complication after intramedullary fixation of trochanteric femoral fracture. Arch Orthop Trauma Surg. 2022; 142: 3715-3720. doi: 10.1007/s00402-021-04193-4.Sakellariou E, Galanis A, Vavourakis M, et al. Periimplant proximal femur fracture in a poliomyelitis survivor: A surgical and medical challenge. Clin Case Rep. 2023; 11: e7465. doi:10.1002/ccr3.7465.Sakellariou E, Galanis A, Vavourakis M, et al. Periimplant proximal femur fracture in a poliomyelitis survivor: A surgical and medical challenge. Clin Case Rep. 2023; 11: e7465. doi:10.1002/ccr3.7465.Leadbetter Guy W. Clinical Orthopaedics and Related Research (1976-2007). 2002; 399: 4-8.Leadbetter Guy W. Clinical Orthopaedics and Related Research (1976-2007). 2002; 399: 4-8.

The authors declare that there are no conflicts of interest present.