Abstract
Objective
To define the common pathology of the hips with irreducible posterior dislocation combined with femoral head fracture and the outcome of surgical treatment using surgical hip dislocation technique.
Design: retrospective observational clinical study
Setting: Level III referral trauma center
Patients/Participants: from January 2011till February 2014 five patients with irreducible posterior hip dislocation and femoral head fracture who underwent operation were included and they followed for at least 18 months.
Intervention
Open reduction and internal fixation of fractured femoral head and labral repair by suture anchors using surgical hip dislocation through trochanteric flip osteotomy approach.
Main Outcome Measures: Clinical and radiographical findings of the irreducible posterior hip dislocation, intraoperative findings, clinical outcomes using Merle d'Aubigné & Postel and Thompson & Epstein scores, and radiological outcome.
Results
All patients presented clinically with a shortened lower limb in neutral or external rotation of the hip (not in Internal rotation). All were Pipkin type II fracture of femoral head with the intact part of the head buttonholed on the posterior wall of the acetabulum through a capsule-labral flap. Postoperative computed tomography revealed perfect reduction except one case with severe comminution with good reduction. Only one patient with delayed operative management developed avascular necrosis and underwent total hip arthroplasty.
Conclusion
Irreducible femoral head fracture-dislocation is rare injury with different clinical presentation that shows neutral or externally rotated limb and optimal surgical management is not clear. Surgical hip dislocation gives full access to the femoral head for reconstruction and opportunity to direct repair of the labral tears.
