A polytrauma patient with an unusual posterior fracture-dislocation of the femoral head: a case report

Abstract

We report a case of a 27-year-old man who was involved in a high-speed car accident. He sustained multiple organ damage including multiple brain petechiae suggesting diffuse axonal damage, aortic dissection, retroperitoneal haematoma and a fracture-dislocation of the right hip with a femoral head fracture and an ipsilateral intertrochanteric fracture. Due to the general condition of the patient, physiological stabilisation was prioritized, and at 2 weeks the fracture-dislocation of the hip was treated with a proximal femoral nail for the intertrochanteric fracture and Herbert screws for the femoral head fracture. Postoperatively, two episodes of recurrent hip dislocation occurred, and this was stabilized eventually with a Steinman pin inserted across the hip joint and taken out 1 month later. Weight-bearing was allowed according to clinical and radiographical assessments. Heterotopic ossification developed around the hip joint, but without evidence of AVN or osteoarthritis. At 18-months follow-up, the fractures had healed and the patient had a Harris Hip score of 79.1. Anatomical reduction and stable fixation of fracture-dislocations of the hip are important for achieving an acceptable result.

Neglected Pipkin's fracture dislocation with bilateral femoral shaft fractures: an unusual combination

“…Osteonecrosis represents a most devastating complication with an incidence range of 6% at an average follow-up of 32 months [ 6 ]. Although various studies [ 1 , 6 – 10 ] report avascular necrosis (AVN) and arthritis incidence from 8 to 25% and 12 to 20%, respectively, with Pipkin's fracture discloations, we attribute early congrous or near congrous reduction, anatomical fixation and early rehabilitation in reducing incidence of AVN and postoperative arthritis, as seen in this case. Radiotherapy and oral indomethacin have both been shown to be of benefit for prophylaxis against heterotopic ossification.…”

“…A hip fracture dislocation with contralateral femur fracture is a rare combination, but the incidence is fast growing due to the increased road accidents. Femoral head fractures were first described by Birkett and fracture dislocations were first described by Pipkin [ 1 ]. These complex injuries require a prompt multidisciplinary approach and involvement of multiple specialties for successful patient management, but a universal treatment protocol is lacking due to the lack of established studies [ 2 – 4 ].…”

Decoding the behaviour of extracapsular proximal femur fracture- dislocation - A systematic review of a rare fracture pattern

“…53 Similar to the contemporary literature, our study revealed strong association between heterotrophic ossification and head-chest injury. 8,15,27,32,54,55 However, the association between the same with the direction of dislocation and the degree of soft tissue injury or intervention was not significant.…”