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Management of two-level proximal femoral fractures
  1. Thom Pauline Maria Johannes Vluggen1,
  2. Raoul van Vugt1,2,
  3. Bert Boonen1 and
  4. Mark Hendrik Franciscus Keulen1,2
  1. 1The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
  2. 2The Department of General Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands
  1. Correspondence to Dr Thom Pauline Maria Johannes Vluggen; t.vluggen{at}


We present the case of an 82-year-old female, who experienced a ground-level fall on the trochanter of the right femur. X-rays showed a proximal femoral fracture (PFF) with an unclear and unusual fracture pattern. Three-dimensional CT images were obtained and showed a displaced femoral neck fracture and ipsilateral fracture of the greater trochanter. Our patient underwent unipolar hemiarthroplasty and fixation of the greater trochanter with a hook plate and cable grip. At 11 months, functional outcomes, patient satisfaction and quality of life were excellent. Primary osteoporosis was diagnosed and treatment with bisphosphonates was initiated.

Two-level PFFs are rare and complex. Due to ageing and a subsequent increase in osteoporosis, numbers of PFFs with complex fracture patterns might increase in the future. Adequate treatment and early prevention of osteoporosis are key to reduce this risk and lower the overall burden. Surgical treatment should be patient-tailored and focus on minimising the risk of complications and reinterventions.

  • hip prosthesis implantation
  • orthopaedic and trauma surgery
  • surgery
  • hip implants

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  • Contributors TPMJV and MHFK conceived, designed and coordinated the study. BB and RvV helped with the data collection. TPMJV and MHFK edited and analysed the data and drafted the manuscript. RvV and BB critically reviewed the manuscript. All authors have read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.