Surgical dislocation of the hip for a locked traumatic posterior dislocation with associated femoral neck and acetabular fractures (original) (raw)
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International Journal of Surgery Case Reports, 2020
INTRODUCTION: Traumatic dislocation of the hip is a very severe injury. Posterior hip dislocation can be associated with acetabular fracture, which can ultimately result in a higher incidence of complications. CASE PRESENTATION: We present a case report of 26-year-old men with a motor vehicle accident and suffered a posterior hip dislocation on left hip joint and acetabular fracture with Judet-Letournel type posterior wall and femoral head fracture. This patient was performed closed reduction, however, due to dynamic instability of hip joint, internal Fixation through Kocher Langenback Approach and insertion of Herbert screws for femoral head and acetabular posterior wall fracture and interfragmentary screw for trochanteric osteotomy. The patient was followed up for 2 years and have a painless hip with full hip range of motion. DISCUSSION: Posterior wall acetabular fractures sometimes occurs after posterior dislocation of the hip. Posterior wall fragment of the acetabular wall fracture can compromise the stability of the hip joint. The reduction can be maintained by closed means or by operative reduction if there is an obstacle to performed closed reduction or followed by sciatic nerve palsy after closed reduction. The complication of operative reduction is avascular necrosis which compromises the integrity of the femoral head and contributing to posttraumatic osteoarthritis. CONCLUSION: Careful examination of acetabular fracture in posterior hip dislocation is required and failed of closed reduction or instability of hip joint are indications to perform open reduction and internal fixation.
Surgical Hip Dislocation for Exposure of the Posterior Column
JBJS Essential Surgical Techniques, 2019
Background: Surgical hip dislocation is performed for safe and efficient management of acetabular fractures predominantly involving the posterior column. The dislocation of the femoral head allows for direct visualization of the hip joint during fracture treatment. Description: The patient is placed in the lateral decubitus position with sterile preparation and draping of the ipsilateral leg to allow for dislocation. The skin incision is straight and centered over the greater trochanter. After the skin incision, the interval between the gluteus maximus and medius muscles is developed. The sciatic nerve is identified, and special attention to the course of the medial circumflex femoral artery is given during dissection of the piriformis and triceps coxae muscles (obturator internus and superior and inferior gemelli muscles). The latter are incised 2 cm posterior to their insertion on the posterior aspect of the greater trochanter. The vastus lateralis muscle belly is elevated from th...
Traumatic Dislocation and Fracture Dislocation of the Hip
Clinical Orthopaedics and Related Research, 1987
Traumatic dislocation and fracture-dislocation of the hip is an absolute orthopedic emergency that is steadily increasing in incidence. Early recognition and prompt, stable reduction is the essence of successful management. A delay in recognition and reduction leads to preventable complications and morbidity. The purpose of this retrospective study is to identify prognostic factors that predict long-term outcome after hip dislocation. Methods: Between 1980 and 1994, 107 patients with traumatic dislocation of the hips were treated, and 62 are reviewed in this study. There were 57 posterior fracture-dislocations and 5 anterior-obturator dislocations. All of the patients' charts were reviewed. The physical examinations and radiologic controls of the patients who were called for last follow-up examination were performed by the first two authors (V.Ş. and E.K.). Anterior and posterior fracture-dislocations were classified according to the classification system developed by Steward and Milford and femoral head fractures were classified according to the Pipkin classification. All of the hips were classified as very good, good, medium, fair, and poor according to the functional evaluation system described by Merle d'Aubigne. Statistical analysis of the results was performed. Results: There were 47 male patients and 15 female patients, with ages ranging from 14 to 72 years (mean, 34.5 years). Traffic accidents constituted the leading cause of traumatic dislocation in this series (52 cases [83.9%]). Associated injuries were found in 44 cases (71%). Fifty patients were treated with closed reduction, and 12 patients were treated with open reduction. Thirty-five hips (56.5%) were reduced within 12 hours. Full weightbearing was resumed between 2 and 10 weeks (average, 8 weeks) after injury. In follow-up periods ranging from 3.6 years to 18.4 years (mean, 9.6 years), 44 patients (71%) had very good or good to medium results. Ten patients (16.1%) developed late posttraumatic osteoarthritis of the hip, and 5 patients (9.6%) developed osteonecrosis of the femoral head. In this study, it is found that the time between injury and reduction and the associated injuries are the most important factors in long-term prognosis. Conclusion: We believe that good results were obtained in patients with early, stable, and accurate reductions by either closed or open methods. Concentric reduction absolutely should be confirmed by radiographs of the pelvis and, if necessary, by computed tomographic scan. The routine use of seat belts could have prevented many of these injuries.
Bilateral Posterior Hip Dislocation Due to Fall from Height: A Case Report
PubMed, 2021
Introduction: Traumatic bilateral posterior hip dislocations are seldom seen. These lesions are associated with fractures of acetabulum, proximal femur, or both. With future complications of such injury, immediate closed reduction remains the mainstay of treatment. A radiographic investigation like computed tomography is very sensitive in detecting fracture fragments and thus forms an important part of hip dislocation management in modern practice. Long-term complications of hip dislocation include chondrolysis, avascular necrosis, and secondary osteoarthritis. Case report: In this case report, we present to you an unusual case 23-year-old male who presented to the emergency department with a history of fall from height with an attitude of flexion adduction and internal rotation deformity of bilateral lower limbs. After ruling out life-threatening injuries, initial radiological work-up composed of plain radiographs and computed tomography was suggestive of bilateral posterior hip dislocation without proximal femur and acetabular fractures. Immediate and prompt concentric hip reduction was achieved under general anesthesia. At 1-year follow-up, the patient had uneventful functional outcome and without radiographic complications. Conclusion: Bilateral posterior hip dislocation is an emergency and requires urgent orthopedic management. The timely and concentric hip reduction is important as it affects the prognosis of such injuries. Computed tomography helps in identifying intra-articular fragments and changes the approach from closed reduction to open reduction. Long-term complications like avascular necrosis should be looked for at regular follow-up.
Surgical dislocation of the hip for the fixation of acetabular fractures
Journal of Bone and Joint Surgery-british Volume, 2010
Surgical dislocation of the hip in the treatment of acetabular fractures allows the femoral head to be safely displaced from the acetabulum. This permits full intra-articular acetabular and femoral inspection for the evaluation and potential treatment of cartilage lesions of the labrum and femoral head, reduction of the fracture under direct vision and avoidance of intra-articular penetration with hardware. We report 60 patients with selected types of acetabular fracture who were treated using this approach. Six were lost to follow-up and the remaining 54 were available for clinical and radiological review at a mean follow-up of 4.4 years (2 to 9). Substantial damage to the intra-articular cartilage was found in the anteromedial portion of the femoral head and the posterosuperior aspect of the acetabulum. Labral lesions were predominantly seen in the posterior acetabular area. Anatomical reduction was achieved in 50 hips (93%) which was considerably higher than that seen in previous reports. There were no cases of avascular necrosis. Four patients subsequently required total hip replacement. Good or excellent results were achieved in 44 hips (81.5%). The cumulative eight-year survivorship was 89.0% (95% confidence interval 84.5 to 94.1). Significant predictors of poor outcome were involvement of the acetabular dome and lesions of the femoral cartilage greater than grade 2. The functional mid-term results were better than those of previous reports. Surgical dislocation of the hip allows accurate reduction and a predictable mid-term outcome in the management of these difficult injuries without the risk of the development of avascular necrosis.