Loupasis et al. Journal of Medical Case Reports 2010, 4:363 http://www.jmedicalcasereports.com/content/4/1/363 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Concomitant ipsilateral subcapital and intertrochanteric fractures of the femur: a case report George Loupasis*, Panagiotis G Ntagiopoulos, Antonios Asimakopoulos Abstract Introduction: We report the case of an unusual combination of concomitant subcapital and intertrochanteric fractures of the hip in a patient after a motorcycle accident. To the best of our knowledge, there is no previous report in the literature of these conditions as a result of high energy trauma or of the treatment used. Case presentation: A 36-year-old Caucasian man was admitted with this rare fracture combination, and was managed with closed fracture reduction and fixation with a dynamic hip screw combined with an anti-rotational cannulated screw. We found four similar cases on reviewing the literature from 1989 to 2009, but these were reports of older patients after low energy injury. Conclusion: We found that segmental fracture of the femoral neck region is an extremely rare and uncategorized hip injury that can occur not only in older people but also in young non-osteoporotic patients, and should be considered for inclusion in femoral fracture classification systems. Introduction Subcapital femoral fractures secondarily complicating internal fixation of previous united intertrochanteric fractures have been infrequently reported in the litera- ture [1-4]. Simultaneous presentation of ipsilateral neck and intertrochanteric femoral fractures are extremely rare, with only four such cases being reported in the lit- erature during the period 1989 to 2009 [5-8]. All these cases occurred in older patients after a low energy injury. We report a case of simultaneous ipsilateral subcapital and intertrochanteric fractures in a 36-year old man after a high-energy trauma from a road traffic accident. Based on our clinical experience, the small number of previously published similar cases, the lack of such a fracture pattern in any classification scheme, and a meti- culous survey of orthopaedic textbook knowledge, we consider that this is an extremely rare fracture combina- tion, and in terms of patient age, mechanism of injury and the treatment followed, it is to the best of our knowledge, the first such report in the literature. * Correspondence: gloupasis@gmail.com 2nd Orthopaedic Clinic, General Hospital of Athens ‘G Gennimatas’, Athens, Greece Case presentation A 36-year-old and otherwise healthy Caucasian man of Greek extraction was admitted to the hospital after been involved in a road traffic accident. Our patient was rid- ing his motorcycle at an approximate speed of 70 mph. He collided head-on with a car, which caused him to be thrown from the motorcycle, landing forcefully on his outstretched left leg. On physical examination, our patient reported pain in his left hip. He was unable to move his left leg, which was shorter than the right and externally rotated. He had no other injuries. Radiographs of the pelvis revealed an undisplaced Garden II subcapital fracture and a dis- placed intertrochanteric fracture, with the fracture line originating from the greater trochanter laterally, and ending above the lesser trochanter medially. This pertro- chanteric fracture could be classified as type 31-A1.1 according to AO/OTA classification (Figure 1)[9]. Our patient was taken to the theatre the same day. Under C-arm fluoroscopy, the intertrochanteric fracture was accurately reduced by closed means, taking care not to apply excessive traction to avoid iatrogenic displace- ment of the subcapital fracture. The fractures were fixed with a 135° dynamic hip screw (DHS) combined with an © 2010 Loupasis et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.