|Beitragstitel||Operative treatment of anterior dislocation in the obturator foramen with associated femoral head and acetabular medial wall fractures: A case report|
Objectives: Traumatic anterior dislocation of the hip joints is a rare condition. Thompson and Epstein described an incidence of 9% of all hip dislocations. Dislocations in the obturator foramen are seen in 6% of all hip dislocations. In up to 75% of the cases associated injuries in the ipsilateral acetabulum or proximal femur are present.
Methods: Clinical outcomes are showed by clinical investigation and scoring by the harris hip score. Radiological outcome was noted by plane radiographs, CT-scan and MRI.
Results: We report a case of an anterior dislocation in the obturator foramen with associated femoral head and acetabular medial wall fractures (Grad IV Stewart and Milford, and Typ V Levin).
The patient was a 22 years old man who was injured in a ski accident on march 2011.
Clinical and radiographic examination showed a dislocation of the right hip on the obturator foramen, with an medial wall fracture and an femoral head impression fracture like Hill-Sachs.
In addition he showed multiples spine fractures (Typ B3 of Th 5 and 6, and apophysis avulsion of the left processus transversus in L2 and L3), an open olecranon fracture on the right elbow (AO 21-B1, Gustillo Grade 2) and a closed scapular fracture.
First trauma care was made in a peripheral hospital with closed reduction of the hip dislocation and ORIF of the olecranon fracture and the patient was transferred in our hospital were a open revision of the right hip was done (17 days after trauma).
The senior author performed an ORIF of the medial wall with osteosuture and refixation of the labrum-capsular complex with 3 bone anchor through a Kocher-Langenbeck- trochanter flip access.
An inter-trochanteric closed wedge valgus osteotomy were performed with internal de-rotation to bring the femoral head lesion out of the weight bearing center and (after adequate shaping) the wedge was used as an autologous bone graft for the reconstruction of the femoral head and fixed with two 2mm traction screws. Osteotomy was finally fixed with a blade plate.
Conclusions: We wants to present ours clinical and radiological midterm results at the follow-up end of 5 years:
The patient showed an excellent clinical outcome and a partial revascularization of the bone graft in the femoral head showed in MRI examination.