Posterior hip fracture-dislocation associated with
posterior wall fracture of the acetabulum and ipsilateral comminuted trochanteric fracture of the femur: A case report.
Int J Surg Case Rep 2022;
94:107075. [PMID:
35427888 PMCID:
PMC9026913 DOI:
10.1016/j.ijscr.2022.107075]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/09/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance
Traumatic posterior dislocation of the hip is often associated with fractures of the femoral head and posterior wall of the acetabulum. However, hip fracture-dislocation that includes the posterior wall of the acetabulum and the ipsilateral femoral trochanter is rare. There is no consensus on the bone that should be operated on first, the operative position, and the choice of implant for femoral fixation.
Case presentation
A 67-year-old man was brought to our emergency department after a 2-m fall. He was diagnosed with a hip fracture-dislocation associated with posterior wall acetabular fracture and ipsilateral femoral trochanteric fracture. Surgical reconstruction was performed with intramedullary nail (IMN) fixation of the femoral trochanteric lesion, followed by anatomically rigid acetabular fixation in the lateral decubitus position. At the 5-year follow-up after the injury, the patient showed good objective and subjective clinical outcomes.
Clinical discussion
Fixing the femur first could allow an easier reduction and traction. The lateral decubitus position was useful, because fixation of the femur and the acetabulum could be performed without changing the position. When fixing the femoral trochanteric lesion, attention was paid to reduce the anteromedial cortex of the proximal fragment extramedullarly to the distal fragment to prevent complications such as cutout and implant breakage.
Conclusion
Anatomically rigid fixation of the posterior wall of the acetabulum secondary to IMN fixation of the femur, with anteromedial cortical support in the lateral decubitus position, could achieve good objective and subjective clinical outcomes.
We report a case of posterior hip fracture-dislocation with fractures of posterior wall and ipsilateral femoral trochanter
This is a rare clinical presentation
For treatment, femoral intramedullary nail fixation is performed first
Then, acetabular posterior wall fixation is performed in lateral decubitus position
Anteromedial cortex of proximal fragment is reduced extramedullarly to distal fragment
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