PMC6588131_01
Plain X-ray: Obturator hip dislocation with medial wall fracture and femoral head impaction.
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F1
He sustained an obturator dislocation of the right hip associated with a severe femoral head impaction fracture in the weight-bearing zone and a medial wall fracture of the acetabulum (Fig. 1, 2, 3).
Transversal computed tomography scan showing the dislocation of the femoral head into the obturator foramen with associated severe femoral head damage and medial wall fracture.
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F2
He sustained an obturator dislocation of the right hip associated with a severe femoral head impaction fracture in the weight-bearing zone and a medial wall fracture of the acetabulum (Fig. 1, 2, 3).
Coronal computed tomography scan after closed reduction showing the extent of the femoral head impaction, some small intra-articular fragments, and the multifragmentary medial wall fracture
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F3
He sustained an obturator dislocation of the right hip associated with a severe femoral head impaction fracture in the weight-bearing zone and a medial wall fracture of the acetabulum (Fig. 1, 2, 3).
Intraoperative view of the femoral head impaction fracture after surgical hip dislocation.
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F4
The local bone situation was assessed afterward: A large (2 cm x 2 cm x 1 cm) osseous head defect was present at the superior junction from head to neck, extending from anterior to posterior (Fig. 4) and the capital head ligament was still intact.
Bleeding of the femoral head through competentanastomoses from the inferior retinacular vessels.
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F5
Despite the complete destruction of the superior retinacular vessels due to the severe impaction at the head-neck junction active bleeding through intraosseous anastomoses from the inferior retinacular vessels was present after a hole of 1.5 mm was drilled in the femoral head (Fig. 5).
Pre-operative planning showing the extent of valgization needed to achieve a
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F6
Then, according to the pre-operative plan (Fig. 6) a 25  closing wedge intertrochanteric osteotomy was performed aiming to turn the head impaction out of the weight-bearing zone.
Reshaping of the head and reinforcement of the neck with a bone block taken at the osteotomy sitecongruous hip joint.
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F7
The large head defect was filled with the reshaped bone block removed at the osteotomy site and stabilized with two 2 mm cortical screws (Fig. 7).
Post-operative radiographs.
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F8
After head reduction, the intertrochanteric osteotomy was stabilized with a 120  blade plate (Depuy Synthes; 4528 Zuchwil Switzerland) and the trochanteric osteotomy with additional 4.5 mm lag screws (Fig. 8).
Radiographs at 5 years
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F9
Radiographs demonstrated union of all osteotomies; osseous integration and remodeling of the bone graft as well as correct congruity and containment of the hip joint, without signs of osteoarthritis (Fig. 9, 10, 11).
Computed tomography in transversal plane at 5 years showing remodeling of the head.
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F10
Radiographs demonstrated union of all osteotomies; osseous integration and remodeling of the bone graft as well as correct congruity and containment of the hip joint, without signs of osteoarthritis (Fig. 9, 10, 11).
Computed tomography in coronal plane at 5 years.
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F11
Radiographs demonstrated union of all osteotomies; osseous integration and remodeling of the bone graft as well as correct congruity and containment of the hip joint, without signs of osteoarthritis (Fig. 9, 10, 11).