CASE REPORT article
Front. Med.
Sec. Geriatric Medicine
This article is part of the Research TopicPerioperative Management and Clinical Challenges in Elderly Major Surgical PatientsView all 10 articles
Integrated Computer-Assisted ORIF and THA for the Management of Acute Femoral Shaft Fracture with Advanced Femoral Head Necrosis:a case report and literature review
Provisionally accepted
- 1Beijing Jishuitan Hospital, Beijing, China
- 2Central Hospital Affiliated to Shenyang Medical College, Shenyang, China
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Background:Acute comminuted femoral shaft fracture combined with end-stage osteonecrosis of the femoral head (ONFH) is a rare and complex clinical condition that often requires multiple surgeries, posing high risks and leading to prolonged recovery. In recent years, computer-assisted preoperative planning has shown promising potential in complex orthopedic procedures, but its application in simultaneously managing long bone fractures and joint replacement remains limited. Case Presentation:We report the case of a male patient in his 70s who was admitted with right thigh pain and deformity after a fall. Imaging revealed a comminuted fracture of the right femoral shaft along with bilateral end-stage avascular necrosis of the femoral heads. After multidisciplinary evaluation, a one-stage surgical strategy was developed using computer-assisted virtual planning and meticulous preoperative design. The patient underwent open reduction and internal fixation (ORIF) of the right femoral shaft combined with ipsilateral total hip arthroplasty (THA). By the first postoperative week, he was able to stand and walk with the aid of a walker. Follow-up showed good fracture healing and significant improvement in hip joint function. The patient was highly satisfied with the outcome and successfully underwent contralateral THA one year later, with similarly positive recovery. Conclusion:Computer-assisted planning offers significant value in the individualized treatment of complex fractures combined with joint pathology. By enabling precise preoperative design and a one-stage surgical approach, it improves treatment efficiency, reduces the number of surgeries, and accelerates functional recovery—providing an effective solution for such challenging cases.
Keywords: Advanced femoral head necrosis, Comminuted femoral shaft fracture, Open reduction andinternal fixation, Total hip arthroplasty, One-Stage surgery
Received: 04 Aug 2025; Accepted: 10 Dec 2025.
Copyright: © 2025 Liang, Chen and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Minghui Yang
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