Knee Injury in Patients Experiencing a High-Energy Traumatic Ipsilateral Hip Dislocation

Introduction: Floating joint injury is an unusual injury pattern that is hard to deal with and often caused by high-energy trauma. In this report, a patient had a homolateral floating hip injury (FHI), floating knee injury (FKI), and hip dislocation at our hospital, and there was no case reported before. Case Presentation: A 48-year-old driver who encountered a traffic accident was seen. Radiologic examination revealed acetabulum comminuted fractures and hip joint posterior dislocation with some fracture pieces in the joint space on the left side. The femur, tibia, and fibula were simultaneously disrupted with open trauma of the left calf. Open reduction and screw-plate fixation of the acetabulum fracture, intramedullary nail fixation of the femoral fracture, and external fixator for his tibia and fibula fracture were carried out. Conclusion: The treatment of multiple fractures should focus on life-threatening injuries above all, and then deal with the fractures according to the situation of the patient. Open reduction and internal fixation are priority choices except in some special cases like where soft tissue is in poor condition. Individual therapy and early rehabilitation are effective for homolateral FHI and FKI.

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KNEE INJURY IN PATIENTS EXPERIENCING A HIGH-ENERGY TRAUMATIC IPSILATERAL HIP DISLOCATION

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200506000-00003 ◽

2005 ◽

Vol 87 (6) ◽

pp. 1200-1204

Author(s):

GARY L. SCHMIDT ◽

ROBERT SCIULLI ◽

GREGORY T. ALTMAN

Keyword(s):

Knee Injury ◽

Hip Dislocation ◽

High Energy

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Management of Pipkin Fractures Using a Safe Surgical Hip Dislocation

Case Reports in Orthopedics ◽

10.1155/2019/3526018 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Rita Henriques ◽

Diogo Ramalho ◽

Joaquim Soares do Brito ◽

Pedro Rocha ◽

André Spranger ◽

...

Keyword(s):

Femoral Head ◽

Avascular Necrosis ◽

Surgical Approach ◽

Trauma Surgery ◽

Hip Dislocation ◽

High Energy ◽

Posttraumatic Arthritis ◽

Surgical Hip Dislocation ◽

Anatomical Reduction ◽

Pipkin Fracture

Introduction. Pipkin fractures are rare events and usually occur as a consequence for high-energy trauma. Surgery to obtain anatomical reduction and fixation is the mainstay treatment for the majority of these injuries; nonetheless, controversy exists regarding the best surgical approach. Description of the Case. We present the case of a 41-year-old male, which sustained a type II Pipkin fracture following a motorcycle accident. In the emergency department, an emergent closed reduction was performed, followed by surgery five days later. Using a surgical hip dislocation, a successful anatomical reduction and fixation was performed. After three years of follow-up, the patient presented with a normal range of motion, absent signs for avascular necrosis or posttraumatic arthritis, but with a grade II heterotopic ossification. Discussion. Safe surgical hip dislocation allows full access to the femoral head and acetabulum, without increasing the risk for a femoral head avascular necrosis or posttraumatic arthritis. Simultaneously, this surgical approach gives the opportunity to repair associated acetabular or labral lesions, which explains the growing popularity with this technique. Conclusion. Although technically demanding, safe surgical hip dislocation represents an excellent option in the reduction and fixation for Pipkin fractures.

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Traumatic Obturator Hip Dislocation with Marginal Femoral Head Fracture in a 15-Year-Old Adolescent: A High-Energy Trauma—A Case Report and a Review of the Literature

Case Reports in Orthopedics ◽

10.1155/2018/7268032 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Yoann Durand ◽

Clémence Bruyère ◽

Marco Saglini ◽

Aurélien Michel-Traverso

Keyword(s):

Femoral Head ◽

Hip Dislocation ◽

High Energy ◽

Hip Pain ◽

X Rays ◽

Hip Function ◽

One Year ◽

High Level ◽

Joint Limitation

We report the case of a 15-year-old boy brought to the emergency department after a bike accident, complaining of an isolated left hip pain. The X-rays showed an obturator hip dislocation treated by closed reduction under general anaesthesia, followed by 6 weeks of discharge. The follow-up MRI performed 6 weeks after the trauma showed an avascular femoral head necrosis, for which we performed multiple retrograde femoral head drilling, completed by the injection of autologue stem cells from the iliaq crest. One year later, the patient has no hip pain, no joint limitation, and can practice BMX at a high level again. The purpose of this report is to make the physicians aware of this rare problem that may be damaging for hip function, especially in young people.

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Iatrogenic Obturator Hip Dislocation with Intrapelvic Migration

Case Reports in Orthopedics ◽

10.1155/2018/5072846 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Shachar Kenan ◽

Spencer Stein ◽

Robert Trasolini ◽

Daniel Kiridly ◽

Bruce A. Seideman

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Closed Reduction ◽

Hip Dislocation ◽

High Energy ◽

Early Assessment ◽

Obturator Foramen ◽

Total Hip ◽

Joint Biomechanics ◽

Hip Abductor

Obturator hip dislocations are rare, typically resulting from high-energy trauma in native hips. These types of dislocations are treated with closed reduction under sedation. Open reduction and internal fixation may be performed in the presence of associated fractures. Still rarer are obturator hip dislocations that penetrate through the obturator foramen itself. These types of dislocations have only been reported three other times in the literature, all within native hips. To date, there have been no reports of foraminal obturator dislocations after total hip arthroplasty. We report of the first periprosthetic foraminal obturator hip dislocation, which was caused iatrogenically during attempts at closed reduction of a posterior hip dislocation in the setting of a chronic greater trochanter fracture. Altered joint biomechanics stemming from a weak hip abductor mechanism rendered the patient vulnerable to this specific dislocation subtype, which ultimately required open surgical intervention. An early assessment and identification of this dislocation prevented excessive closed reduction maneuvers, which otherwise could have had detrimental consequences including damage to vital intrapelvic structures. This case report raises awareness to this very rare, yet potential complication after total hip arthroplasty.

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Inveterate (42-year-old) Hip Dislocation Treated with Arthroplasty. A Case Study

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/15093492.1238034 ◽

2017 ◽

Vol 19 (2) ◽

pp. 175-182

Author(s):

Tomasz Pitera ◽

Grzegorz Guzik ◽

Piotr Biega

Keyword(s):

Hip Dislocation ◽

Treatment Method ◽

High Energy ◽

Road Accident ◽

Computed Tomography Images ◽

Appropriate Treatment ◽

Diagnostic Work ◽

The Right ◽

Work Up

Dislocation of the hip usually results from a high-energy injury sustained during a road accident. Inveterate dislocations persisting for many months or years are extremely rare. Selection of an appropriate treatment method is not easy and is always associated with the risk of serious complications. The present authors hope that a description of the course of diagnostic work-up and treatment of a patient in whom a hip dislocation persisted for 42 years will prove interesting and helpful for orthopaedists who may encounter such a case in their practice. The patient sustained a dislocation of the right hip in 1974. He did not agree to undergo reduction immediately after the injury. Initially, he experienced extremely severe pain and difficulty walking, but gradually learned to walk without crutches and even took up a job. The limb was considerably shortened with only minimal movement in the hip joint. The pelvic geometry was altered and spinal scoliosis developed. In the last several years, the patient experienced a significant increase in pain and a decrease in function that prevented him from walking unassisted. Following a thorough physical examination, and based on computed tomography images, the patient was qualified for hip arthroplasty. An analysis of the available literature prompted the present authors to use a cemented implant and not to use bone grafts. Early treatment outcomes are good.

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Fractures of the femoral head: a narrative review

EFORT Open Reviews ◽

10.1302/2058-5241.6.210034 ◽

2021 ◽

Vol 6 (11) ◽

pp. 1122-1131

Author(s):

Maximilian M. Menger ◽

Benedikt J. Braun ◽

Steven C. Herath ◽

Markus A. Küper ◽

Mika F. Rollmann ◽

...

Keyword(s):

Femoral Head ◽

Surgical Approach ◽

Motor Vehicle ◽

Hip Dislocation ◽

High Energy ◽

Femoral Head Fracture ◽

Concomitant Injuries ◽

Vehicle Accidents ◽

Joint Congruity

Fractures of the femoral head are rare injuries, which typically occur after posterior hip dislocation. The Pipkin classification, developed in 1957, is the most commonly used classification scheme to date. The injury is mostly caused by high-energy trauma, such as motor vehicle accidents or falls from a significant height. Emergency treatment consists of urgent closed reduction of the hip joint, followed by non-operative or operative treatment of the femoral head fracture and any associated injuries. There is an ongoing controversy about the suitable surgical approach (anterior vs. posterior) for addressing fractures of the femoral head. Fracture location, degree of displacement, joint congruity and the presence of loose fragments, as well as concomitant injuries are crucial factors in choosing the adequate surgical approach. Long-term complications such as osteonecrosis of the femoral head, posttraumatic osteoarthritis and heterotopic ossification can lead to a relatively poor functional outcome. Cite this article: EFORT Open Rev 2021;6:1122-1131. DOI: 10.1302/2058-5241.6.210034

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“Acute Primary Total Hip Arthroplasty for Combined Posterior Acetabulum Fracture with Ipsilateral Associated Posteriorly Dislocated Femoral Head with Femoral Neck Fracture. Using of Femoral Head as an Autograft Would be an Advantage”

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i04.2164 ◽

2021 ◽

Vol 11 (4) ◽

Author(s):

Babaji Thorat ◽

Avtar Singh ◽

Mohammad Arshad ◽

Sharad Salokhe ◽

Ravi Mavani

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Hip Dislocation ◽

High Energy ◽

Acetabular Reconstruction ◽

Total Hip ◽

Neck Fracture ◽

Posterior Hip Dislocation

Introduction: Traumatic posterior hip dislocation with comminuted fracture of the ipsilateral acetabulum and femoral neck is a rare fracture pattern. These injuries are associated with high energy trauma and pose challenges during management. Controversy exists between hip preservation and replacement surgeries in middle-age patients. Open reduction and internal fixation (ORIF) have a high risk of non-union, avascular necrosis, and post-traumatic osteoarthritis of hip requiring total hip arthroplasty hip replacement (THA) as a secondary procedure later. Case Report: A 56-year-old male presented with posterior hip dislocation and comminuted fracture of ipsilateral wall and column of the acetabulum, and femoral neck following a high energy trauma. He was managed by acetabular reconstruction using femoral head structural autograft combined with acute primary uncemented THA. At 2-year follow-up, the patient had good functional outcome with a satisfactory range of motion without any difficulty in weight-bearing and doing his daily activities. Conclusion: Although uncommon, acetabular reconstruction using femoral head structural autograft and acute primary uncemented THA is a viable alternative treatment option compared to ORIF in middle-age patients with fracture of ipsilateral neck and acetabulum. This facilitates post-operative rehabilitation and avoids further operations for possible developing AVN or secondary arthritis. Keywords: Hip dislocation, acetabulum fracture, femur neck fracture, acute total hip arthroplasty, acetabular reconstruction, femoral head structural autograft.

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Primary repair of multiligament knee injury with InternalBrace ligament augmentation

BMJ Case Reports ◽

10.1136/bcr-2021-247173 ◽

2022 ◽

Vol 15 (1) ◽

pp. e247173

Author(s):

Paul Andre Paterson-Byrne ◽

William Thomas Wilson ◽

Graeme Philip Hopper ◽

Gordon M MacKay

Keyword(s):

Knee Injury ◽

Primary Repair ◽

Knee Dislocation ◽

High Energy ◽

Surgical Reconstruction ◽

Ligament Augmentation ◽

Multiligament Knee Injury ◽

Returning To Work ◽

Viable Approach ◽

Arterial Damage

Multiligament injury of the knee usually occurs as a result of high-energy trauma causing tibiofemoral dislocation. These are rare but potentially limb-threatening injuries, frequently involving nerve or arterial damage and often leading to severe complex instability. Management generally favours surgical reconstruction of the affected ligaments, with controversy regarding optimal treatment. We present a severe multiligament knee injury (Schenk classification KD-IV involving both cruciate and both collateral ligaments) in a competitive showjumper. A combined arthroscopic/open technique of single-stage surgical repair and suture augmentation was used, repairing all affected ligaments. The patient made an excellent recovery, returning to work after 12 weeks and riding after 22 weeks. After 5-year follow-up, she has regained her previous level of competition without subsequent injury. Multiligament repair with suture augmentation is a viable approach to the management of knee dislocation injuries. We propose that this could provide superior outcomes to traditional reconstruction techniques using autograft or synthetic reconstruction.

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OSS Implant Fracture as a Complication of Resection Arthroplasty Performed Following High-energy Knee Injury. Case Study

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0013.1917 ◽

2019 ◽

Vol 21 (2) ◽

pp. 129-138

Author(s):

Piotr Wodziński ◽

Szymon F. Dragan ◽

Artur Krawczyk( ◽

Mirosław Kulej ◽

Szymon Ł. Dragan

Keyword(s):

Functional Recovery ◽

Knee Injury ◽

Femoral Fractures ◽

Technical Difficulty ◽

Bone Defects ◽

High Energy ◽

Resection Arthroplasty ◽

Tumour Resection ◽

High Level

Treatment of high-energy distal femoral fractures is highly demanding. Advances in osteosynthesis techniques now allow for successful treatment, but extensive bone defects associated with the injury can preclude stable bone healing. Modular arthroplasty may be an effective alternative in such cases. Most commonly used during periarticular tumour resection procedures, modular arthroplasty enables functional recovery of the limb. It has been proven to be effective also in traumatic bone defects. The most important limitation of this method is a high level of technical difficulty and possible complications that may require reoperation. The most common complications are infections, periprosthetic fractures and implant wear and loosening. This report presents a case of high-energy injury to the distal femur, with a considerable bone defect treated successfully by modular post resection arthroplasty using a Biomet OSS implant. A spontaneous implant fracture occurred nine years after surgery. This complication had not been previously described in the available literature. A revision arthroplasty was performed with similar implants, resulting in functional recovery of the limb and patient satisfaction.

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