Hip dislocation associated with ipsilateral femoral neck and shaft fractures: an unusual combination and dilemma regarding head preservation

Öz

Traumatic posterior hip dislocation associated with a fracture of the femoral neck is a rare injury. The combination of posterior dislocation of the femoral head with ipsilateral femoral neck and shaft fractures is even rarer, with only one such case reported in literature. We present the case of a 50-year-old man, with traumatic posterior dislocation of the hip, and fractures of the femoral neck and shaft, in addition to an undisplaced superior pubic ramus fracture of the acetabulum. Osteosynthesis of the femoral shaft fracture followed by open reduction of the femoral head and fixation of the neck was undertaken, while taking care not to damage the intact retinaculum on the posterosuperior aspect of the femoral neck. The radiographs revealed union of all fractures without evidence of avascular necrosis of the femoral head at final follow-up of two years. This case is of particular interest as it highlights some of the important factors in deciding between head preservation versus arthroplasty for this complex fracture-dislocation.

Anahtar Kelimeler

• Dislocation
• femur
• femoral neck
• ipsilateral
• fracture

İpsilateral femur boyun ve şaft kırığı ile birlikte olan kalça çıkığı: Sıradışı bir yaralanma ve osteosentez kararı

Öz

Femur boyun kırığı ile birlikte oluşan travmatik posterior kalça çıkığı nadir bir yaralanmadır. İpsilateral femur boyun ve şaft kırığı ile birlikte femur başı posterior çıkığı ise literatürde geçen tek bir örneği ile daha da nadir bir yaralanmadır. Bu çalışmada, asetabulumda deplase olmayan superior pubik ramus kırığı, travmatik posterior kalça çıkığı, femur boyun ve şaft kırığı olan 50 yaşında erkek bir hastayı değerlendirdik. Femur şaft kırığı osteosentezini takiben femur boyun posterosuperiorundaki sağlam retinakulum korunarak femur başına açık redüksiyon ve femur boynuna fiksasyon yapıldı. Ameliyattan 2 yıl sonraki takipte çekilen grafilerde, femur başında avasküler nekroz gelişmediği ve bütün kırıkların kaynadığı görüldü. Çalışmamızda bu kompleks kırıklı çıkık yaralanmasında artroplasti veya femur başını koruma kararını etkileyen faktörleri değerlendirdik.

Anahtar Kelimeler

• Çıkık; femur; femur boynu; ipsilateral; kırık.

Kaynakça

1. Dümmer RE, Sanzana ES. Hip dislocations associ- ated with ipsilateral femoral neck fracture. Int Orthop 1999;23:353-4. CrossRef
2. Esenkaya I, Görgeç M. Traumatic anterior dislocation of the hip associated with ipsilateral femoral neck fracture: a case report. Acta Orthop Traumatol Turc 2002;36:366-8.
3. McClelland SJ, Bauman PA, Medley CF Jr, Shelton ML. Obturator hip dislocation with ipsilateral fractures of the femoral head and femoral neck. A case report. Clin Or- thop Relat Res 1987;224:164-8.
4. Mehara AK, Das Ramchandani G, Sharma CS, Bhardwaj V, Gupta RG. Unusual posterior hip dislocation with ip- silateral fractures of the femoral neck and head. J Trauma 1995;38:658-9. CrossRef
5. Tannast M, Mack PW, Klaeser B, Siebenrock KA. Hip dislocation and femoral neck fracture: decision-making for head preservation. Injury 2009;40:1118-24. CrossRef
6. Duygulu F, Calis M, Argun M, Guney A. Unusual com- bination of femoral head dislocation associated acetabular fracture with ipsilateral neck and shaft fractures: A case report. J Trauma 2006;61:1545-8. CrossRef
7. Izquierdo RJ, Harris D. Obturator hip dislocation with subcapital fracture of the femoral neck. Injury 1994;25:108-10. CrossRef
8. Klasen HJ, Binnendijk B. Fracture of the neck of the fe- mur associated with posterior dislocation of the hip. J Bone Joint Surg Br 1984 ;66:45-8.

9. Mears DC, Velyvis JH. Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results. J Bone Joint Surg Am 2002;84-A:1-9.
10. Boraiah S, Ragsdale M, Achor T, Zelicof S, Asprinio DE. Open reduction internal fixation and primary total hip arthroplasty of selected acetabular fractures. J Orthop Trauma 2009;23:243-8. CrossRef
11. Watson JT, Moed BR. Ipsilateral femoral neck and shaft fractures: complications and their treatment. Clin Orthop Relat Res 2002;399:78-86. CrossRef
12. Yip KM. The use of customized long stem hemiarthro- plasty in ipsilateral femoral neck and pending shaft frac- ture: case report. Bull Hosp Jt Dis 1996;55:81-2.
13. Bedi A, Karunakar MA, Caron T, Sanders RW, Haiduke- wych GJ. Accuracy of reduction of ipsilateral femoral neck and shaft fractures--an analysis of various internal fixation strategies. J Orthop Trauma 2009;23:249-53. CrossRef
14. Upadhyay SS, Moulton A, Srikrishnamurthy K. An analysis of the late effects of traumatic posterior disloca- tion of the hip without fractures. J Bone Joint Surg Br 1983;65:150-2.
15. Baba T, Hitachi K, Kaneko K. Fracture-dislocation of the hip with ipsilateral femoral neck fracture. Eur J Orthop Surg Traumatol. 2002;12:102-104. CrossRef
16. Fina CP, Kelly PJ. Dislocations of the hip with fractures of the proximal femur. J Trauma 1970;10:77-87. CrossRef
17. Sadler AH, DiStefano M. Anterior dislocation of the hip with ipsilateral basicervical fracture. A case report. J Bone Joint Surg Am 1985;67:326-9.
18. Fernandes A. Traumatic posterior dislocation of hip joint with a fracture of the head and neck of the femur on the same side: a case report. Injury 1981;12:487-90. CrossRef