{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:45Z","timestamp":1756339545385,"version":"3.44.0"},"reference-count":40,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,5,10]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:p>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.<\/jats:p>\n               <jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2020-240684","type":"journal-article","created":{"date-parts":[[2021,5,31]],"date-time":"2021-05-31T16:07:55Z","timestamp":1622477275000},"page":"e240684","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Management of two-level proximal femoral fractures"],"prefix":"10.1136","volume":"14","author":[{"given":"Thom Pauline Maria Johannes","family":"Vluggen","sequence":"first","affiliation":[{"name":"The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raoul","family":"van Vugt","sequence":"additional","affiliation":[{"name":"The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands"},{"name":"The Department of General Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bert","family":"Boonen","sequence":"additional","affiliation":[{"name":"The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark Hendrik Franciscus","family":"Keulen","sequence":"additional","affiliation":[{"name":"The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands"},{"name":"The Department of General Surgery, Zuyderland Medical Centre Heerlen, Heerlen, Limburg, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,5,31]]},"reference":[{"key":"2025082710270851000_14.5.e240684.1","doi-asserted-by":"crossref","first-page":"46","DOI":"10.5152\/eurjrheum.2016.048","article-title":"An overview and management of osteoporosis","volume":"4","author":"S\u00f6zen","year":"2017","journal-title":"Eur J Rheumatol"},{"key":"2025082710270851000_14.5.e240684.2","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5413.73656"},{"key":"2025082710270851000_14.5.e240684.3","doi-asserted-by":"crossref","first-page":"516","DOI":"10.5272\/jimab.2014204.516","article-title":"Epidemiology and social burden of the femoral neck fractures","volume":"20","author":"Filipov","year":"2014","journal-title":"JofIMAB"},{"key":"2025082710270851000_14.5.e240684.4","doi-asserted-by":"crossref","first-page":"721","DOI":"10.3928\/0147-7447-19890501-11","article-title":"Simultaneous ipsilateral intertrochanteric and subcapital fracture of the hip. A case report","volume":"12","author":"An","year":"1989","journal-title":"Orthopedics"},{"key":"2025082710270851000_14.5.e240684.5","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/0020-1383(89)90179-4","article-title":"Segmental fracture of the neck of the femur","volume":"20","author":"Pemberton","year":"1989","journal-title":"Injury"},{"key":"2025082710270851000_14.5.e240684.6","first-page":"535","article-title":"Simultaneous ipsilateral pertrochanteric and subcapital fractures","volume":"22","author":"Cohen","year":"1999","journal-title":"Orthopedics"},{"key":"2025082710270851000_14.5.e240684.7","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/BF01706667","article-title":"A rare combination fracture of the neck of femur","volume":"11","author":"Kumar","year":"2001","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"2025082710270851000_14.5.e240684.8","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.injury.2006.07.054","article-title":"Concomitant ipsilateral subcapital and intertrochanteric fractures of the femur","volume":"38","author":"Poulter","year":"2007","journal-title":"Injury Extra"},{"key":"2025082710270851000_14.5.e240684.9","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/1752-1947-2-68","article-title":"Concomitant ipsilateral intracapsular and extracapsular femoral neck fracture: a case report","volume":"2","author":"Perry","year":"2008","journal-title":"J Med Case Rep"},{"key":"2025082710270851000_14.5.e240684.10","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.ijscr.2014.03.012","article-title":"Segmental neck of femur fractures: a unique case report of an ipsilateral subcapital, greater trochanteric and intertrochanteric fracture and proposed management algorithm","volume":"5","author":"Tahir","year":"2014","journal-title":"Int J Surg Case Rep"},{"key":"2025082710270851000_14.5.e240684.11","doi-asserted-by":"crossref","first-page":"600","DOI":"10.2174\/1874325001711010600","article-title":"Combined intracapsular and extracapsular neck of femur fractures case series, literature review and management recommendations","volume":"11","author":"Khan","year":"2017","journal-title":"Open Orthop J"},{"key":"2025082710270851000_14.5.e240684.12","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1097\/00005131-199304000-00008","article-title":"Concomitant ipsilateral intertrochanteric and subcapital fracture of the hip","volume":"7","author":"Isaacs","year":"1993","journal-title":"J Orthop Trauma"},{"key":"2025082710270851000_14.5.e240684.13","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s00068-005-1413-5","article-title":"Concomitant ipsilateral pertrochanteric and subcapital fracture of the proximal femur","volume":"31","author":"Sayegh","year":"2005","journal-title":"Eur J Trauma"},{"key":"2025082710270851000_14.5.e240684.14","doi-asserted-by":"crossref","unstructured":"Butt MF , Dhar SA , Hussain A . Femoral neck fracture with ipsilateral trochanteric fracture: is there room for osteosynthesis. Internet J Orthop Surg 2007;5.","DOI":"10.5580\/14e9"},{"key":"2025082710270851000_14.5.e240684.15","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1177\/230949900801600227","article-title":"Osteosynthesis for a T-shaped fracture of the femoral neck and trochanter: a case report","volume":"16","author":"Dhar","year":"2008","journal-title":"J Orthop Surg"},{"key":"2025082710270851000_14.5.e240684.16","doi-asserted-by":"crossref","DOI":"10.1186\/1752-1947-4-363","article-title":"Concomitant ipsilateral subcapital and intertrochanteric fractures of the femur: a case report","volume":"4","author":"Loupasis","year":"2010","journal-title":"J Med Case Rep"},{"key":"2025082710270851000_14.5.e240684.17","doi-asserted-by":"crossref","first-page":"82","DOI":"10.4103\/0019-5413.54765","article-title":"Ipsilateral femoral neck and trochanter fracture","volume":"45","author":"Neogi","year":"2011","journal-title":"Indian J Orthop"},{"key":"2025082710270851000_14.5.e240684.18","first-page":"16","article-title":"Ipsilateral concomitant displaced vertical femoral neck fracture and unstable 4-part trochanteric fracture: a case report","volume":"14","author":"Kim","year":"2019","journal-title":"J Orthop Trauma Surg Rel Res"},{"key":"2025082710270851000_14.5.e240684.19","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and dislocation classification Compendium-2018","volume":"32 Suppl 1","author":"Meinberg","year":"2018","journal-title":"J Orthop Trauma"},{"key":"2025082710270851000_14.5.e240684.20","doi-asserted-by":"crossref","DOI":"10.1186\/s13018-017-0528-9","article-title":"A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis","volume":"12","author":"Xu","year":"2017","journal-title":"J Orthop Surg Res"},{"key":"2025082710270851000_14.5.e240684.21","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.injury.2014.10.010","article-title":"Complications following young femoral neck fractures","volume":"46","author":"Slobogean","year":"2015","journal-title":"Injury"},{"key":"2025082710270851000_14.5.e240684.22","doi-asserted-by":"crossref","DOI":"10.1051\/sicotj\/2015028","article-title":"Lower reoperation rate for cemented femoral stem than for uncemented femoral stem in primary total hip arthroplasty following a displaced femoral neck fracture","volume":"1","author":"Andersen","year":"2015","journal-title":"Sicot J"},{"key":"2025082710270851000_14.5.e240684.23","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-015-4345-3"},{"key":"2025082710270851000_14.5.e240684.24","doi-asserted-by":"crossref","first-page":"15","DOI":"10.2106\/00004623-199401000-00003","article-title":"Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports","volume":"76","author":"Lu-Yao","year":"1994","journal-title":"J Bone Joint Surg Am"},{"key":"2025082710270851000_14.5.e240684.25","doi-asserted-by":"crossref","DOI":"10.1186\/s13018-017-0629-5","article-title":"Comparison of arthroplasty vs. osteosynthesis for displaced femoral neck fractures: a meta-analysis","volume":"12","author":"Tseng","year":"2017","journal-title":"J Orthop Surg Res"},{"key":"2025082710270851000_14.5.e240684.26","doi-asserted-by":"publisher","DOI":"10.1080\/17453670610046262"},{"key":"2025082710270851000_14.5.e240684.27","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-004-0572-z"},{"key":"2025082710270851000_14.5.e240684.28","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200102000-00027"},{"key":"2025082710270851000_14.5.e240684.29","doi-asserted-by":"publisher","DOI":"10.1016\/S0883-5403(87)80045-1"},{"key":"2025082710270851000_14.5.e240684.30","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-013-3308-9"},{"key":"2025082710270851000_14.5.e240684.31","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.00006"},{"key":"2025082710270851000_14.5.e240684.32","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0068903","article-title":"Cemented versus uncemented hemiarthroplasty for femoral neck fractures in elderly patients: a meta-analysis","volume":"8","author":"Li","year":"2013","journal-title":"PLoS One"},{"key":"2025082710270851000_14.5.e240684.33","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-004-1725-z"},{"key":"2025082710270851000_14.5.e240684.34","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-148-3-200802050-00198"},{"key":"2025082710270851000_14.5.e240684.35","doi-asserted-by":"publisher","DOI":"10.7326\/M15-1361"},{"key":"2025082710270851000_14.5.e240684.36","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.D.02289"},{"key":"2025082710270851000_14.5.e240684.37","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.01246"},{"key":"2025082710270851000_14.5.e240684.38","doi-asserted-by":"publisher","DOI":"10.1007\/s001980200015"},{"key":"2025082710270851000_14.5.e240684.39","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-010-1411-2"},{"key":"2025082710270851000_14.5.e240684.40","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-012-1520-9"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-240684","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:27:15Z","timestamp":1756315635000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-240684"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,31]]},"published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1136\/bcr-2020-240684"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-240684","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,5]]}}}