|
1
|
Jadib I, Rachidi HE, Abdennaji S, Messoudi A, Rafai M. Irreducible posterior fracture-dislocation of the hip associated with an ipsilateral femoral shaft fracture: A case report and review of the literature. Int J Surg Case Rep 2024; 124:110365. [PMID: 39396491 PMCID: PMC11563161 DOI: 10.1016/j.ijscr.2024.110365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 09/23/2024] [Accepted: 09/28/2024] [Indexed: 10/15/2024] Open
Abstract
INTRODUCTION Ipsilateral fractures of the shaft of the femur combined with hip dislocations are extremely rare injuries, presenting a difficult diagnostic and therapeutic challenge. Diagnosis of hip dislocation is often delayed, due to the focus on femoral fracture. CASE PRESENTATION This article presents a case never described before of a 19-year-old patient who sustained this unusual combination of injuries as a result of a road traffic accident. The patient had an irreducible posterior hip fracture-dislocation associated with an ipsilateral femoral shaft fracture. Closed reduction attempts were unsuccessful, leading to the requirement for open reduction, via the posterolateral approach of the hip, which revealed that the femoral head buttonholed through the capsule. We proceeded to the reduction of the left hip with the osteosynthesis of the posterior wall acetabular fragment, and then the femur shaft fracture was fixed using an intramedullary nail. After 19 months postoperative follow-up, the patient had full range motion of the affected hip without any pain. DISCUSSION Closed reduction techniques, including various external devices, have been explored, with some success in specific cases. However, open reduction remains a crucial option, especially in irreducible dislocations. Complications, such as avascular necrosis of the femoral head and neurovascular injury, illustrate the importance of accurate diagnosis and appropriate treatment. CONCLUSIONS In conclusion, ipsilateral femoral shaft fractures combined with hip dislocations represent a rare and challenging orthopedic emergency. Timely diagnosis, careful assessment, and consideration of both closed and open reduction techniques are essential in managing these complex injuries.
Collapse
Affiliation(s)
- Imad Jadib
- Department of Orthopedics and Trauma-Surgery (P32), Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy Hassan-II, Casablanca, Morocco.
| | - Houssam Eddine Rachidi
- Department of Orthopedics and Trauma-Surgery (P32), Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy Hassan-II, Casablanca, Morocco
| | - Soufiane Abdennaji
- Department of Orthopedics and Trauma-Surgery (P32), Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy Hassan-II, Casablanca, Morocco
| | - Abdeljebbar Messoudi
- Department of Orthopedics and Trauma-Surgery (P32), Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy Hassan-II, Casablanca, Morocco
| | - Mohamed Rafai
- Department of Orthopedics and Trauma-Surgery (P32), Ibn Rochd University Hospital Center, Faculty of Medicine and Pharmacy Hassan-II, Casablanca, Morocco
| |
Collapse
|
|
2
|
Xu Y, Lv M, Yu SQ, Liu GP. Closed reduction of hip dislocation associated with ipsilateral lower extremity fractures: A case report and review of the literature. World J Clin Cases 2022; 10:12654-12664. [PMID: 36579117 PMCID: PMC9791526 DOI: 10.12998/wjcc.v10.i34.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/17/2022] [Accepted: 11/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Traumatic hip dislocation usually occurs following high-velocity trauma. It is imperative that the dislocation be reduced in a timely manner, especially in a closed manner, as an orthopedic emergency. However, closed reduction can hardly be achieved in patients who also have ipsilateral lower extremity fractures. Herein, we focus on hip dislocation associated with ipsilateral lower extremity fractures, excluding intracapsular fractures (femoral head and neck fractures), present an early closed hip joint reduction method for this injury pattern, and review the literature to discuss the appropriate closed reduction technique for this rare injury pattern.
CASE SUMMARY We report a case of a 37-year-old male who sustained a left acetabular posterior wall fracture, an ipsilateral comminuted subtrochanteric fracture and dislocation of the hip. The hip dislocation was reduced urgently in a closed manner using the joy-stick technique with a T-shaped Schanz screw. The fractures were reduced and fixed as a 2nd-stage surgery procedure. At the 17-month postoperative follow-up, the patient had full range of motion of the affected hip.
CONCLUSION Closed reduction of a hip dislocation associated with ipsilateral lower extremity fractures is rarely achieved by regular maneuvers. Attempts at closed reduction, by means of indirectly controlling the proximal fracture fragment or reconstructing the femoral leverage rapidly with the aid of various external reduction apparatuses, were shown to be effective in some scenarios. Mandatory open reduction is indicated in cases of failed closed reduction, particularly in irreducible dislocations.
Collapse
Affiliation(s)
- Yong Xu
- Department of Orthopaedics, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Ming Lv
- Department of Orthopaedics, Zibo Central Hospital, Shandong University, Zibo 255000, Shandong Province, China
| | - Shu-Qiang Yu
- Department of Orthopaedics, The Fourth People's Hospital of Zibo, Zibo 255000, Shandong Province, China
| | - Guang-Ping Liu
- Department of Orthopaedics, Zibo Central Hospital, Shandong University, Zibo 255000, Shandong Province, China
| |
Collapse
|
|
3
|
Lai PJ, Lai CY, Tseng IC, Su CY, Hsu YH, Chou YC, Yu YH. A retrospective study of hip posterior fracture-dislocation: closed reduction at the emergency department or in the operation theater? J Orthop Traumatol 2022; 23:55. [PMID: 36459307 PMCID: PMC9718901 DOI: 10.1186/s10195-022-00677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND For hip posterior fracture-dislocation, the current consensus is to perform joint reduction within 6 h to prevent sequelae. However, whether a closed reduction (CR) should be performed at the emergency department (ED) or in the operation theater (OT) remains debatable. We aimed to assess the incidence and factors predictive of CR failure at the ED in patients with hip posterior fracture-dislocation. METHODS Patients with hip posterior fracture-dislocation between 2009 and 2019 were included. Age, sex, body mass index (BMI), injury severity score, new injury severity score, time from injury to first reduction attempt (TIR), presence of associated femoral head fracture, posterior wall marginal impaction, and posterior wall fragment size were compared between patients with CR success and patients with CR failure at the ED. RESULTS Fifty-five patients with hip posterior fracture-dislocation experienced CR attempts at the ED and were enrolled in the study. Thirty-eight (69.1%) hips were reduced successfully at the ED, and 17 (30.9%) experienced failure. No significant differences in age, sex, BMI, presence of femoral head fracture, marginal impaction, or size of the posterior wall fragment were found between the groups. TIR was significantly shorter in the successful CR group (2.24 vs. 4.11 h, p = 0.01). According to receiver operating characteristic curve analysis, 3.5 h was the cut-off time. CONCLUSIONS For patients with hip posterior fracture-dislocation, TIR was a critical factor for successful CR. If the time interval exceeds 3.5 h from injury, the success rate of bedside CR at the ER is likely to decrease, and the OT should be prepared in case of failed bedside CR. LEVEL OF EVIDENCE III
Collapse
Affiliation(s)
- Po-Ju Lai
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302 Tao-Yuan City, Taiwan
| | - Chih-Yang Lai
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302 Tao-Yuan City, Taiwan
| | - I-Chuan Tseng
- The Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan branch, Tao-Yuan City, Taiwan
| | - Chun-Yi Su
- The Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung City, Taiwan
| | - Yung-Heng Hsu
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302 Tao-Yuan City, Taiwan
| | - Ying-Chao Chou
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302 Tao-Yuan City, Taiwan
| | - Yi-Hsun Yu
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302 Tao-Yuan City, Taiwan
| |
Collapse
|
|
4
|
Yoon YC, Oh CW, Kim JW, Heo J, Song HK. Safety of surgical hip dislocation in femoral head fracture and dislocation (FHFD) and avascular necrosis risk factor analysis of FHFD: midterm results confirmed by SPECT/CT and MRI. J Orthop Surg Res 2022; 17:278. [PMID: 35578301 PMCID: PMC9109337 DOI: 10.1186/s13018-022-03160-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/03/2022] [Indexed: 11/20/2022] Open
Abstract
Background The study aim was to report the treatment outcomes of trochanteric flip osteotomy (TFO) with surgical hip dislocation (SHD) for femoral head fracture and dislocation (FHFD) and to investigate the risk factors for avascular necrosis (AVN) of the femoral head. Methods The data of 34 patients (29 men, 5 women; mean age 37.9 years) diagnosed with FHFD and treated with TFO with SHD between May 2009 and February 2018 with an average follow-up period of 5.1 years (range 2.8–10.5 years) were analyzed. Clinical outcomes were evaluated using the Merle d'Aubigné–Postel score and Thompson–Epstein Scale. Radiologic outcomes were classified according to the Matta classification. AVN was confirmed using magnetic resonance imaging or single-photon emission computed tomography/computed tomography. The occurrence of complications was examined, and factors influencing complications, AVN. Results Regarding the Pipkin’s classification, there were 7 patients with type II, 2 patients with type III, and 25 patients with type IV fractures. Posterior wall fractures accompanied all associated acetabular fractures in the patients with Pipkin type IV fractures. Radiologically, the union of acetabular and femoral head fractures was observed within 6.1 months on average (range 4–10 months) in 32 patients, except two patients who developed femoral head AVN. Clinically, the average Merle d'Aubigné–Postel score was 14.4 points (range 8–17 points), and 22 patients had good or excellent results on the Thompson–Epstein Scale. Two patients developed femoral head AVN with both having displaced femoral neck fractures associated with FHFD. AVN was significantly correlated with femoral neck fractures (P = 0.000). Conclusion TFO with SHD is a safe and useful approach for the treatment of FHFD. Particular attention should be paid when treating femoral head fractures associated with displaced femoral neck fractures because of the high risk of AVN development.
Collapse
|
|
5
|
王 浩, 纪 振, 周 志, 宋 夏, 韩 天. [Characteristics and clinical significance of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:263-267. [PMID: 35293164 PMCID: PMC8923935 DOI: 10.7507/1002-1892.202108056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/11/2022] [Indexed: 01/24/2023]
Abstract
Objective To summarize the characteristics and clinical significance of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. Methods The clinical data of 4 patients with irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations between January 2010 and December 2019 were collected. There were 2 males and 2 females and the age ranged from 24 to 41 years, with an average age of 33.5 years. The cause of injury included traffic accident in 3 cases and falling in 1 case. Pipkin classification was 2 cases of type Ⅰ and 2 cases of type Ⅱ. The time from injury to operation was 1-2 days. The clinical features were that the hip joint of the affected limb was in a locked position, and the passive range of motion was poor. The affected limb was slightly flexed at the hip joint and shortened, in a state of neutral position or slight adduction and internal rotation. The imaging data suggested that the femoral head dislocated backward and upward, and the hard cortex of the posterior edge of the acetabulum was embedded in the cancellous bone of the femoral head, and the two were compressed and incarcerated. Patients of cases 1-3 underwent closed reduction of hip dislocation 1-2 times at 3, 1, and 3 hours after injury respectively, and femoral neck fracture occurred. The injury types changed to Pipkin type Ⅲ, and open reduction and internal fixation were performed. Patient of case 4 did not undergo closed reduction, but underwent open reduction and internal fixation directly. Results Patients of cases 1-3 were followed up 14, 17, and 12 months, respectively. They developed osteonecrosis of the femoral head at 9, 5, and 10 months after operation respectively, and all underwent total hip arthroplasty. Patient of case 4 was followed up 24 months and had no hip pain and limited mobility; the imaging data indicated that the internal fixator position was good and the fracture healed; no collapse or deformation of the femoral head was seen, and no osteonecrosis of the femoral head occurred. Conclusion Clinicians need to improve their understanding of the unique clinical features and imaging findings of irreducible Pipkin type Ⅰ and Ⅱ femoral head fracture-dislocations. It is suggested that open reduction and simultaneous fixation of femoral head fracture should be directly used to reduce the incidence of osteonecrosis of the femoral head.
Collapse
Affiliation(s)
- 浩然 王
- 中国人民解放军北部战区总医院骨科（沈阳 110016）Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang Liaoning, 110016, P. R. China
| | - 振钢 纪
- 中国人民解放军北部战区总医院骨科（沈阳 110016）Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang Liaoning, 110016, P. R. China
| | - 志斌 周
- 中国人民解放军北部战区总医院骨科（沈阳 110016）Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang Liaoning, 110016, P. R. China
| | - 夏楠 宋
- 中国人民解放军北部战区总医院骨科（沈阳 110016）Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang Liaoning, 110016, P. R. China
| | - 天宇 韩
- 中国人民解放军北部战区总医院骨科（沈阳 110016）Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang Liaoning, 110016, P. R. China
| |
Collapse
|
|
6
|
Letter to the editor regarding "Failed reduction of posterior hip dislocation accompanied by femoral head fracture: causes and resolving strategy". INTERNATIONAL ORTHOPAEDICS 2020; 45:1645. [PMID: 33205342 DOI: 10.1007/s00264-020-04879-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
|