Traumatic hip dislocation with associated femoral head fracture.
Bottom Line: Dislocation of the hip is a critical injury that results from high-energy trauma.After 15-month follow-up, a full range of motion has been achieved and there are no signs of avascular necrosis, hip instability, or limping.The authors describe their method of surgery.
Affiliation: Golestan Hospital, Tehran 1668644611, Iran.
Dislocation of the hip is a critical injury that results from high-energy trauma. This paper describes a case of posterior dislocation of the right hip in a 35-year-old woman with associated ipsilateral femoral head fracture. Initial treatment included reduction of the right hip through posterior approach and fixation of the femoral head fracture with three absorbable screws. After 15-month follow-up, a full range of motion has been achieved and there are no signs of avascular necrosis, hip instability, or limping. The authors describe their method of surgery.
No MeSH data available.
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Mentions: In February 2012, a 35-year-old female suffered from a high-velocity accident. She had been unable to weight bear since the injury. The patient was transferred to the nearest hospital by EMS. On admission, the injury was closed and there were no accompanying injuries. Popliteal and ankle pulses were palpable on the right foot and neurosensory examination was normal. Her blood pressure and pulse rate were within normal limits. No other injuries or skin lesions except bruising were noted on physical examination. Direct radiographs revealed posterior dislocation of right hip. This kind of injury often occurs when the knee hits the dashboard in a collision. This force drives the thigh backwards, which drives the ball head of the femur out of the hip socket. Closed reduction was performed under general anesthesia and she was discharged from the hospital. Four days later, the patient presented to our hospital with a complaint of limitation of motion in the right hip. Her general condition was stable. Further radiographs (Figure 1) and magnetic resonance imaging of the hip (Figures 2(a) and 2(b)) were performed and showed a large fragment of the femoral head fracture that was unreduced with incongruity of hip joint. At operation, the hip was exposed through a posterior approach. The short external rotators (gemelli and obturator internus) were preserved during the approach. Hip capsule rupture was clearly seen. At operation, the femoral head was taken out from acetabulum with minimal rotation and maneuver through the ruptured capsule of hip joint. The femoral head split to three parts, two large fragments and a small one. Under direct observation, we reduced fragments and fixed them preliminarily with small pins. The pins were over-drilled with a cannulated drill bit. Then with countersink, the entry site was deepened a few millimeters near the screw head size. Consecutively, the fracture was fixed with three large absorbable screws. Good spherical head and fixation were achieved. Finally the operated femoral head was reduced. Postoperatively, the patient was mobilized non-weight-bearing on crutches for eight weeks. At monthly follow-up, good union of fracture parts and spherical femoral head with no signs of avascular necrosis have been seen. At the latest follow-up (15 months after injury), radiographs (Figure 3), computed tomography (Figure 4), and MRI (Figure 5) of the hip showed no evidence of avascular necrosis (AVN) of the femoral head. She had a full range of motion with no hip instability, pain, or limping.
No MeSH data available.