Rana Rajesh, Verma Deepak, Behera Sudarsan, Behera Himansu, Raulo Binod
Orthopaedics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND.
Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND.
Cureus. 2020 Dec 8;12(12):e11969. doi: 10.7759/cureus.11969.
Femoral head fracture-dislocations are rare, and irreducible cases are even less frequent. Truly irreducible fracture-dislocations must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. The Pipkin classification is commonly used to classify femoral head fractures. An urgent reduction is required in traumatic hip dislocations to reduce the risk of avascular necrosis (AVN) of the femoral head. However, in femoral head fractures, the dislocated hip cannot be reduced easily due to incarcerated bone or soft tissue. In an irreducible fracture hip dislocation, It is not advisable to attempt to reduce it repeatedly because sometimes femoral head fracture-dislocation is associated with the impacted fracture of the femoral neck. It may lead to iatrogenic femoral neck fracture. Hence, in such cases, immediate open reduction and internal fixation are recommended. The Kocher-Langenbeck approach can be used for reduction and safe surgical dislocation with flip trochanteric osteotomy for fixation as a novel approach.
股骨头骨折脱位较为罕见，而无法复位的病例更是少见。真正无法复位的骨折脱位必须与因嵌顿骨或软组织嵌入导致的复位不完全相鉴别。皮普金分类法常用于对股骨头骨折进行分类。创伤性髋关节脱位需要紧急复位，以降低股骨头缺血性坏死（AVN）的风险。然而，在股骨头骨折中，由于嵌顿骨或软组织的存在，脱位的髋关节不易复位。在无法复位的骨折性髋关节脱位中，反复尝试复位并不可取，因为有时股骨头骨折脱位与股骨颈嵌插骨折相关。这可能导致医源性股骨颈骨折。因此，在这种情况下，建议立即进行切开复位内固定。科克伦-朗根贝克入路可用于复位和安全的手术脱位，并采用翻转粗隆截骨术进行固定，这是一种新方法。
