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Salvage of Femoral Head in a 4 Months Old Neglected Fracture Dislocation of Hip — A Case Report


Affiliations
1 Jai Prakash Narayan Apex Trauma Center, AIIMS, Raj Nagar, New Delhi -110029, India
2 Dayanand Medical College, Ludhiana, India
     

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Background

We present a case of fracture dislocation hip which was missed at the time of injury and presented to us after 4 months of injury. There is no clear consensus regarding the management of neglected unreduced posterior fracture dislocation of hip.

Case Report

A 28 years old male presented with deformity and pain in the left hip for past 4 months. He had been involved in a motor vehicle accident 4 months earlier. At the time of presentation to us, left hip was fixed in flexed, adducted and internally rotated position. The extremity was short and there was significant atrophy of the gluteal muscles. There was no sign of neurovascular injury. Roentgenographic images and computed tomography scans revealed communited fracture of femoral head and the posterior acetabular rim with postero-superior dislocation of left hip. MRI was done to assess the viability of femoral head which showed no signs of avascular necrosis of femoral head. Due to the presence of intra-articular fragment, open reduction using posterior approach to the hip was used. Sequential soft tissue release was done. Trochanteric flip osteotomy was done to gain exposure and preserve vascularity of femoral head. At 2 years follow up, patient has no pain and no gross instability. Roentgenograph showed union at the osteotomy site and there were no signs of avascular necrosis and secondary osteoarthritis.

Conclusion

Because of the inevitable complications of AVN and secondary osteoarthritis in a neglected fracture dislocation of hip, many authors recommend primary arthroplasty. However, it appears reasonable to suggest that open reduction followed by a period of traction should be considered as an alternative treatment for young adults with a viable head.


Keywords

Avascular Necrosis, Osteoarthritis, Trochanteric Flip Osteotomy
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  • Salvage of Femoral Head in a 4 Months Old Neglected Fracture Dislocation of Hip — A Case Report

Abstract Views: 501  |  PDF Views: 3

Authors

Divesh Jalan
Jai Prakash Narayan Apex Trauma Center, AIIMS, Raj Nagar, New Delhi -110029, India
Vijay Sharma
Jai Prakash Narayan Apex Trauma Center, AIIMS, Raj Nagar, New Delhi -110029, India
Ramakant Kumart
Jai Prakash Narayan Apex Trauma Center, AIIMS, Raj Nagar, New Delhi -110029, India
Tushar Gupta
Jai Prakash Narayan Apex Trauma Center, AIIMS, Raj Nagar, New Delhi -110029, India
Kamran Farooque
Jai Prakash Narayan Apex Trauma Center, AIIMS, Raj Nagar, New Delhi -110029, India
Gupta Mayank
Dayanand Medical College, Ludhiana, India

Abstract


Background

We present a case of fracture dislocation hip which was missed at the time of injury and presented to us after 4 months of injury. There is no clear consensus regarding the management of neglected unreduced posterior fracture dislocation of hip.

Case Report

A 28 years old male presented with deformity and pain in the left hip for past 4 months. He had been involved in a motor vehicle accident 4 months earlier. At the time of presentation to us, left hip was fixed in flexed, adducted and internally rotated position. The extremity was short and there was significant atrophy of the gluteal muscles. There was no sign of neurovascular injury. Roentgenographic images and computed tomography scans revealed communited fracture of femoral head and the posterior acetabular rim with postero-superior dislocation of left hip. MRI was done to assess the viability of femoral head which showed no signs of avascular necrosis of femoral head. Due to the presence of intra-articular fragment, open reduction using posterior approach to the hip was used. Sequential soft tissue release was done. Trochanteric flip osteotomy was done to gain exposure and preserve vascularity of femoral head. At 2 years follow up, patient has no pain and no gross instability. Roentgenograph showed union at the osteotomy site and there were no signs of avascular necrosis and secondary osteoarthritis.

Conclusion

Because of the inevitable complications of AVN and secondary osteoarthritis in a neglected fracture dislocation of hip, many authors recommend primary arthroplasty. However, it appears reasonable to suggest that open reduction followed by a period of traction should be considered as an alternative treatment for young adults with a viable head.


Keywords


Avascular Necrosis, Osteoarthritis, Trochanteric Flip Osteotomy

References