Surgical Treatment by Anterior Approach of Femoral Head Dislocation Fracture (About 3 Cases and Literature Review)

Case Report

Austin J Orthopade & Rheumatol. 2019; 6(1): 1076.

Surgical Treatment by Anterior Approach of Femoral Head Dislocation Fracture (About 3 Cases and Literature Review)

Dehayni B1*, Amarir M2, Jalal Y1, Zaddoug O1, Bennis A1, Benchakroune M1, Zine A1, Tanane M1, Edderai M1 and Jaafar A1

¹Department of Traumatology and Orthopedics, Mohamed V Military Training Hospital, Faculty of Medicine and Pharmacy, Mohamed V University, Morocco

²Department of Medical Imaging, Mohamed V Military Training Hospital, Faculty of Medicine and Pharmacy, Mohamed V University, Morocco

*Corresponding author: Dehayni Badreddine, Department of Traumatology and Orthopedics, Mohamed V Military Training Hospital, Faculty of Medicine and Pharmacy, Mohamed V University, RABAT, Morocco

Received: August 05, 2019; Accepted: September 16, 2019; Published: September 23, 2019

Abstract

Femoral head dislocation fracture is a rare lesion that is often associated with hip dislocation. However, we reported a retrospective study on a series of three cases, collected in our service, which were diagnosed and treated urgently, with a good evolution in 2/3 of the cases. The literature review confirms the rarity of the lesion. Radiological diagnosis is not always easy, it should be assisted by a CT scan. Irreducibility is frequent. Choosing the right approach is difficult. Knowledge of all hip approach pathways allows the osteochondral fragment of the head to be approached for removal or fixation after reduction. Good management does not always prevent certain complications. Total hip replacement surgery from the outset always keeps its indications.

Keywords: Femoral head dislocation fracture; CT scan; Anterior approach

Introduction

Femoral head dislocation fracture is a rare lesion that is often associated with hip dislocation. And raises various problems: anatomo-radiological study of the lesion in emergency, a Difficulty of reduction and early or late complications that condition the functional prognosis of the hip.

Case Presentation

This is a retrospective study collected at the Traumatology- Orthopaedics I Department of Mohamed V Military Hospital in Rabat, over a period of 2 years, yet over a series of three young patients with no significant pathological history, it is 2 men and 1 woman, with an average age of 32 years, all of whom were victims of a road accident (high energy mechanism) with dashboard syndrome. They presented an isolated trauma of the right hip (02 cases) and left hip (01 cases). The clinical examination found a shortened lower limb, in flexion and internal rotation. Pain in active and passive mobilization. Vascular-nervous examination was without particularity, the examination of the above and underlying joints is without anomalies. Standard face pelvis, face and profile radiographs Hip supplemented by 3D reconstruction CT scan, all our patients presented a posterior superior hip dislocation with a femoral head fracture (Figures 1-3) classified as Stage II according to Pipkin’s classification. After a failed attempt to reduce hip dislocation by external maneuvers without surgery under anesthesia in two patients. These two patients received a reduction in emergency dislocation under general anesthesia by open surgery with orthopedic table with osteosynthesis by screwing the cephalic fragment by the anterior approach of the traumatized hip (Figure 3). One case had a good reduction without surgery (Figure 4), operated with a screwing 48 hours later.