Orthopedic Center 1 Department of Orthopedic Trauma, Suining Central Hospital, Suining City, China.
Medicine (Baltimore). 2023 Nov 24;102(47):e36275. doi: 10.1097/MD.0000000000036275.
Traumatic hip dislocation with ipsilateral femoral neck fracture, intertrochanteric fracture and acetabular fracture is a rare and serious injury that occurs mostly in young patients and after high-energy trauma. The treatment of these injuries is a major challenge for orthopedic surgeons; it can have devastating consequences if not treated properly, including avascular necrosis of the femoral head and traumatic osteoarthritis of the hip. In previous case reports only internal fixation of femoral neck fracture was performed without revascularisation and there was a lack of long-term follow-up results. In this report, we fixed the fracture revascularised the patient, and obtained good prognostic results at up to 20 months of follow-up.
Here, we report an 18-year-old patient with systemic polytrauma resulting from a car accident. The trauma included ipsilateral posterior hip dislocation, acetabular fracture, femoral intertrochanteric fracture, and femoral neck fracture. In addition, the patient also had an ipsilateral open tibiofibula fracture. We chose the surgical treatment of a proximal femoral locking compression plate (PFLCP), femoral quadratus bone flap graft, and cannulated compression screw to treat the proximal femoral fracture. The patient was followed up for nearly 20 months; the range of motion of his hip was close to normal, and his hip function was good.
Traumatic hip dislocation with ipsilateral femoral neck fracture, intertrochanteric fracture and acetabular fracture is a rare and serious injury, and surgical intervention is often needed. Because of the high risk of femoral head necrosis in such complex injuries, it is very important to protect/restore the blood supply of the femoral head during surgery. Therefore, in younger patients, we believe that the use of a quadratus femoris bone flap graft and PFLCP is an acceptable treatment for this severe injury. We discuss the management of this rare case and review the current literature to provide the best evidence-based recommendations for this injury pattern. We conclude that for patients with complex ipsilateral proximal femoral and acetabular fractures combined with hip dislocation, the key to surgical treatment, in addition to anatomic reduction and good fixation, is the primary reconstruction of the femoral head blood supply.
髋关节外伤性脱位合并同侧股骨颈骨折、股骨转子间骨折和髋臼骨折是一种罕见且严重的损伤，主要发生在年轻患者和高能创伤后。这些损伤的治疗对骨科医生来说是一个重大挑战；如果处理不当，可能会产生毁灭性的后果，包括股骨头缺血性坏死和髋关节创伤性骨关节炎。在之前的病例报告中，仅对股骨颈骨折进行了内固定，而没有进行血运重建，并且缺乏长期随访结果。在本报告中，我们对患者进行了骨折固定和血运重建，并在长达 20 个月的随访中获得了良好的预后结果。
我们报告了一例 18 岁患者因车祸导致全身多发创伤。创伤包括同侧髋关节后脱位、髋臼骨折、股骨转子间骨折和股骨颈骨折。此外，患者还伴有同侧开放性胫腓骨骨折。我们选择使用近端股骨锁定加压钢板（PFLCP）、股骨四方骨瓣移植和空心加压螺钉治疗股骨近端骨折。患者接受了近 20 个月的随访；其髋关节活动度接近正常，髋关节功能良好。
髋关节外伤性脱位合并同侧股骨颈骨折、转子间骨折和髋臼骨折是一种罕见且严重的损伤，通常需要手术干预。由于此类复杂损伤股骨头坏死的风险较高，因此在手术中保护/恢复股骨头的血液供应非常重要。因此，对于年轻患者，我们认为使用四方骨瓣移植和 PFLCP 是治疗这种严重损伤的一种可接受的方法。我们讨论了这种罕见病例的处理方法，并回顾了当前的文献，为这种损伤模式提供了最佳的循证推荐。我们得出结论，对于合并髋关节脱位的复杂同侧股骨近端和髋臼骨折患者，手术治疗的关键除了解剖复位和良好固定外，还在于股骨头血供的初步重建。
