Salvage of Femoral Head in a 4 Months Old Neglected Fracture Dislocation of Hip — A Case Report
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.
- Brumback RJ, Kenzora JE, Levitt LE, Burgess AR, Poka A. Fractures of the femoral head. In: Proceedings of the Hip Society. St. Louis: CV Mosby 1987:181-206.
- Butler JE. Pipkin type-II fractures of the femoral head. J Bone Joint Surg Am 1981; 63:1292-1296.
- Chakraborti SS, Miller IM. Dislocation of the hip associated with fracture of the femoral head. Injury1975; 7:134-142.
- Epstein HC, Wiss DA, Cozen L. Posterior fracture dislocation of the hip with fractures of the femoral head. Clin Orthop 1985; 201:9-17.
- Marchetti ME, Steinberg GG, Coumas JM. Intermediate-term experience of Pipkin fracture-dislocations of the hip. J Orthop Trauma 1995; 10:455-461.
- Brav EA. Traumatic dislocation of the hip: Army experience and results over twelve-year period. J Bone Joint Surg Am 1962;44:1115-1134.
- Hougaard K, Thomsen PB. Coxarthrosis following traumatic posterior dislocation of the hip. J Bone Joint Surg Am 1987; 69:679-683.
- Stewart MJ, Milford LW. Fracture-dislocation of the hip: An end-result study. J Bone Joint Surg Am 1954; 36:315-342.
- Gupta RC, Shravat BP. Reduction of neglected traumatic dislocation of the hip by heavy traction. J Bone Joint Surg Am 1977; 59:249-251.
- Garrett JC, Epstein HC, Harris WH. Treatment of unreduced traumatic posterior dislocation of the hip. J Bone Joint Surg Am 1979; 61:2-6.
Abstract Views: 528
PDF Views: 3