Femur Neck Fracture in a Patient with Klippel-Trenaunay Syndrome- Case Report

Author(s): Fabio Seiji Mazzi Yamaguchi, Leandro Ejnisman, Julio Parente, Daniel Teixeira Bussius, Bruno Alves Rudelli, Helder de Souza Miyhara, Henrique Melo de Campos Gurgel

Klippel-Trenaunay Syndrome (KTS) is a rare congenital disorder characterized by a triad of capillary malformation with port-wine stain, varicose veins, or venous malformation of the lower limbs, and bony and soft tissue hypertrophy. In this case report, we present the case of a 47-year-old woman who was diagnosed with KTS in her left lower limb at the age of 22. She was admitted to the Hip Group Ambulatory at the Hospital das Clinicas of Sao Paulo, Brazil, due to osteoarthritis in her left hip joint caused by KTS. The patient suffered a Garden 4 left femoral neck fracture after falling from a standing position. Based on imaging, physical examination, and vascular evaluation, our initial surgical plan was Total Hip Arthroplasty (THA) with bone graft and acetabular cage via the posterior approach. However, due to significant blood loss, hemodynamic instability, and the presence of large vessels close to the acetabulum, we decided to abort the initial plan of THA and instead opted for Resection Arthroplasty of Girdlestone. KTS is a challenge for orthopedic surgeons and requires a multidisciplinary evaluation. Patients with KTS who undergo THA require a radiologic study of malformations to choose an appropriate surgical approach, despite the high risk of bleeding.