Irreducible Fracture-Dislocations of the Femoral Head Without Posterior Wall Acetabular Fractures

Neglected traumatic fracture dislocation of the hip is a challenging problem due to soft tissue contractures, adhesions, fibro fatty tissue filling acetabulum, avascular necrosis, arthritis and myositis ossificans. These types of injury often get missed at initial evaluation in the presence of distracting injuries and in poly trauma patients. Femoral head fractures account for only 7-16% of all hip fracture dislocations, with combined femoral head and acetabular fractures in elderly being even lower. Literature favours primary hip replacement as compared to hip salvage in age above 60 years and in patients with neglected hip fracture dislocations of more than 3 months duration due to high chances of afore mentioned complications. Here, we report a case of 69 years old male with neglected hip fracture dislocation associated with posterior acetabular wall and femoral head fracture for the challenges in management with a total hip replacement.

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Avascular necrosis of the femoral head in the patients with posterior wall acetabular fractures associated with dislocations of the hip

Acta chirurgica iugoslavica ◽

10.2298/aci1302065m ◽

2013 ◽

Vol 60 (2) ◽

pp. 65-69 ◽

Cited By ~ 4

Author(s):

Sasa Milenkovic ◽

Milorad Mitkovic ◽

Jordan Saveski ◽

Ivan Micic ◽

Predrag Stojiljkovic ◽

...

Keyword(s):

Femoral Head ◽

Young Patients ◽

Hip Dislocation ◽

Posterior Wall ◽

Acetabular Fractures ◽

Type I ◽

Severe Injuries ◽

Stable Osteosynthesis ◽

Posterior Hip Dislocation

Introduction: Acetabular fractures are severe injuries, mostly occured in young patients after traffic accident or fall from heights. Of the all acetabular fractures, posterior wall acetabular fractures are the most often observed. Regarding to mechanism of the injury, about 30% of these fractures are associated with posterior hip dislocation. Material and methods: The incidence of AVN in 18 patients with posterior wall acetabular fractures associated with dislocations of the hip is presented. Thompson-Epstein Scale (type I-V) was used as the classification of the injury. Kocher-Langenbeck surgical approach was achieved in all patients. Results: Average following time after surgery was 22,66 months (8-36 months). After that period the incidence of femoral head AVN was observed in 33,3%6. Femoral head AVN was observed in 5,55%1 of patient who was treated by the reduction of hip dislocation in first 24 hours after injury, while in patients with later reduction, femoral head AVN were observed in 27,77%5. Conclusion: Posterior wall acetabular fractures associated with hip dislocation are severe injuries. Urgent, closed reduction of the hip, early definitive stable osteosynthesis of acetabulum and the experience of surgical team are factors that greatly decrease the possibility for AVN occurrence. Later reduction, comminution of posterior wall of the acetabulum (Thompson-Epstein III et IV), impaction, chondral lesion of the femoral head and associated fractures of femoral head, increase the possibility for AVN occurrence.

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Treatment of Incarcerated Impaction of Acetabular Fractures With Concomitant Osteochondral Femoral Head Fractures by the Use of a Posterior Wall Osteotomy and Surgical Hip Dislocation

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-18-00789 ◽

2019 ◽

Vol 27 (24) ◽

pp. e1086-e1092 ◽

Cited By ~ 1

Author(s):

Ioannis V. Papachristos ◽

Joey P. Johnson ◽

Peter V. Giannoudis

Keyword(s):

Femoral Head ◽

Hip Dislocation ◽

Posterior Wall ◽

Acetabular Fractures ◽

Surgical Hip Dislocation

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Midterm results of trochanteric flip osteotomy technique for management of fractures around the hip

Hip International ◽

10.5301/hipint.5000539 ◽

2017 ◽

Vol 28 (2) ◽

pp. 148-155 ◽

Cited By ~ 3

Author(s):

Vivek Trikha ◽

Saubhik Das ◽

Arkesh Madegowda ◽

Prabhat Agrawal

Keyword(s):

Femoral Head ◽

Excellent Result ◽

Hip Dislocation ◽

Posterior Wall ◽

Acetabular Fractures ◽

Functional Evaluation ◽

Midterm Results ◽

Surgical Hip Dislocation ◽

Surgical Dislocation ◽

Trochanteric Flip Osteotomy

Introduction: In this study, we aimed to investigate safety and efficacy of the trochanteric flip osteotomy with surgical hip dislocation technique in selected displaced acetabular and femoral head fractures with clinico-radiological outcome and potential complications. Materials and methods: We retrospectively reviewed 32 patients from January 2009 to June 2014. Selected displaced acetabular fractures with comminution and/or cranial extension of posterior wall, marginal impaction, intraarticular fragment, femoral head fractures and hip fracture-dislocations were operated by this modified approach of trochanteric flip osteotomy and surgical hip dislocation. Patients were evaluated for fracture reduction, femoral head viability, trochanteric union, abduction power, and functional evaluation was done by Merle d’Aubigné-Postel scoring system. Minimum follow-up was 24 months. Results: Reduction was judged to be anatomical in 84.38% of cases, and within 1-3 millimetres in 9.38% of cases. All osteotomies healed in an anatomical position. Heterotopic ossification was found in 2 patients limited to Brooker class I. Osteonecrosis developed in 1 patient. 2 patients developed arthritis of the hip as sequelae of poor reduction. Abduction power was MRC 5/5 in all except in 1 patient (4/5). Mean Merle d’Aubigné-Postel score was 16.18; overall good to excellent result was achieved in 87.5% of cases. Conclusions: Trochanteric flip osteotomy with surgical dislocation allows better intraarticular assessment, control of intraarticular fragments, assists accurate reduction and the fixation of complex acetabular and femoral head fractures, without compromising femoral head vascularity and abductor strength. This technique has provided excellent midterm results in the management of complex injuries around the hip.

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Neglected posterior acetabular wall fracture managed with uncemented total hip arthroplasty with posterior wall reconstruction by femoral head autograft: a case report

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20181812 ◽

2018 ◽

Vol 4 (3) ◽

pp. 527

Author(s):

Ram Avtar ◽

Varun Khanna ◽

Krishan Kumar

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Preoperative Evaluation ◽

Posterior Wall ◽

Harris Hip Score ◽

Acetabular Fractures ◽

Total Hip ◽

Uncemented Total Hip Arthroplasty ◽

Post Traumatic

Total hip arthroplasty (THA) poses several challenges as a treatment option for acetabular fracture especially in the setting of a neglected fracture. The potential technical challenges of THA include the altered anatomy and hip centre, acetabular bone deficit, difficulty in achieving long-term fixation of the acetabular shell and risk of nerve injury. In our case, a forty two years old, male labrourer presented with a five months old injury, which was previously managed only conservatively. Preoperative evaluation revealed displaced posterior wall acetabulum with superiorly migrated femur head with flattened contour. We managed the case with uncemented THA. The acetabular defect was addressed using the femoral head autograft which was secured with screws. On three months follow up, radiographical evalution showed good graft consolidation without any acetabular component migration and functionally a Harris hip score of 76. Thus, in case of neglected acetabular fractures, with high probability of post traumatic arthritis to develop, THA remains the preferred choice of management. Albeit challenging to perform, THA provides effective way to decrease pain, improve stability and increase functional outcomes.

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Effects of the acetabular fracture index and other factors of posterior wall acetabular fracture on functional outcome

Journal of International Medical Research ◽

10.1177/0300060517709816 ◽

2017 ◽

Vol 45 (4) ◽

pp. 1394-1405 ◽

Cited By ~ 2

Author(s):

Hai-Tao Long ◽

Zhen-Han Deng ◽

Min Zou ◽

Zhang-Yuan Lin ◽

Jian-Xi Zhu ◽

...

Keyword(s):

Physical Therapy ◽

Femoral Head ◽

Functional Outcome ◽

Avascular Necrosis ◽

Lower Limb ◽

Acetabular Fracture ◽

Posterior Wall ◽

Functional Score ◽

Related Data ◽

Limb Fracture

Objective To analyze the effects of the acetabular fracture index (AFI) and other factors on the functional outcome of patients with acetabular fractures involving the posterior wall. Methods Forty-eight patients who underwent surgery in our department were reviewed. According to the AFI, which indicates the percentage of remaining intact posterior acetabular arc, the patients were divided into Group A (AFI ≤ 25%, 11 patients), Group B (25% < AFI ≤ 50%, 23 patients), Group C (50% < AFI ≤ 75%, 7 patients), and Group D (75% < AFI ≤ 100%, 7 patients). The AFI was measured with a computed tomography picture archiving and communication system or calculated with the cosine theorem. A nonparametric test and ordinal regression were used to determine the role of the AFI and other factors on the functional outcome. Perioperative information, including demographic and fracture-related data, reduction quality, physical therapy duration, association with a lower limb fracture and avascular necrosis of the femoral head were prospectively gathered. Results The mean AFIs of A, B, C, and D groups were 14.3%, 35.9%, 59.5%, and 81.2%, respectively. No statistically significant differences were observed among the groups for demographic and fracture-related data. A better reduction quality (OR = 4.21, 95%CI 1.42 ∼ 12.43, χ2 = 6.781, P = 0.009) and a larger value of AFI (OR = 2.56, 95%CI 1.18 ∼ 5.55, χ2 = 5.648, P = 0.017) result in a higher functional score. The functional outcome of a physical therapy duration of more than 12 months (OR = 0.15, 95%CI 0.02 ∼ 0.90, χ2 = 4.324, P = 0.038) was better than that of less than 12 months. Lower limb fracture (OR = 0.13, 95%CI 0.02 ∼ 0.74, χ2 = 5.235, P = 0.022) and avascular necrosis of femoral head (OR = 0.02, 95%CI 0.00 ∼ 0.87, χ2 = 4.127, P = 0.042) were found to correlate with a lower functional score. Conclusion With a greater of AFI, the functional outcome score would be better. Other factors, including reduction quality, physical therapy duration, association with a lower limb fracture, and avascular necrosis of the femoral head, most likely also affect hip functional recovery.

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