Deep wound infection after a trochanteric fracture internal fixation presenting with hip dislocation: a case report

Abstract

We report a rare case of posterior hip dislocation after a low energy trauma. The patient sustained a trochanteric fracture in the same hip six months ago, which was fixed using a sliding hip screw and had healed. At surgery a deep wound infection was found and a methicillin-resistant Staphylococcus epidermidis (MRSE) was cultured. After thorough debridement, an excisional arthroplasty was decided. The patient received specific intravenous antibiotics and after six weeks a total hip arthroplasty was done. In three years follow-up the patients presented with a fully functional hip without any signs of infection. Hip dislocation after a trochanteric fracture internal fixation is rare complication associated with high morbidity and mortality. Infection eradication and a second stage arthroplasty can be life and limb saving.

Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures

“…One was managed by single stage where as the second case required two-stage surgery (spacer of antibiotic-impregnated cement modeled around a guidewire for the first stage). Tzurbakis et al ,22 reported a single case of deep wound infection after a trochanteric fracture internal fixation presenting with hip dislocation for which excisional arthroplasty was done as first stage and THA was done 6 weeks later. Our study has a series of 20 patients of failed infected internal fixation of hip.…”

Subtle hip joint subluxation after femoral neck fracture fixation: an ominous sign in a report of two cases

“…12 Once a septic subluxation has occurred with associated changes in the femoral head and acetabulum, the only viable treatment option is debridement and resection arthroplasty followed by a replacement procedure later. [1][2][3]6 The authors believe that subluxation without hip pain after surgery should be viewed with concern and should raise the suspicion of a deep-seated infection. Subtle hip subluxation and increased medial joint space are often missed on radiographs and only detected retrospectively; however, these can be very early and reliable radiographic signs pointing to a deep septic process in a postoperative hip joint.…”

“…Most have been reported to occur after trochanteric fracture fixation with a screw-plate combination. [1][2][3][4] A subluxation or dislocation after internal fixation of femoral neck fractures is even more uncommon, and almost all reported cases involve basicervical fractures fixed with a screw-plate combination. [5][6][7][8] To the best of the authors' knowledge, hip subluxation or dislocation after fixation of a transcervical femoral neck fracture with a minimally invasive implant like a cannulated cancellous screw (CCS) has not been reported in the literature to date.…”

“…6 The deep sepsis in such cases is usually a low-grade infection caused by Staphylococcus aureus or epidermidis presenting without any systemic signs. 1,2,10 The outcome in both septic and aseptic dislocations is mostly poor, and often replacement surgery is needed. 6 This report presents two patients with hip subluxation after minimally invasive fixation of displaced transcervical femoral neck fractures with CCS.…”

Spontaneous non-traumatic dislocation of the hip as a complication of screw-plate fixation of a femoral neck fracture

“…Tzurbakis in 2010 reported a 78-year-old female with a hip dislocation after a deep infection on a trochanteric fracture treated with a sliding hip screw [13] . Infection and hip joint laxity were the reasons to which the authors explained the dislocation.…”