PMC2839317_01
Initial right hip x-ray showing a posterior fracture-dislocation of the femoral head with an associated intertrochanteric fracture
11751_2009_78_Fig1_HTML.jpg
PMC2839317_01_11751_2009_78_Fig1_HTML.jpg
Fig1
X-rays of the chest and pelvis were performed showing bilateral clavicle fractures, a widened mediastinum and a fracture-dislocation of the right hip (Fig. 1).
CT scan of the pelvis. aCoronal view. Posterior fracture-dislocation of the femoral head. bCoronal view. Intertrochanteric hip fracture. c 3D reconstruction image. Anterior view. d 3D reconstruction image. Posterior view
11751_2009_78_Fig2_HTML.jpg
PMC2839317_01_11751_2009_78_Fig2_HTML.jpg
Fig2
A computed tomography (CT) body scan was obtained and showed multiple petechiae in the brain suggesting diffuse axonal injury, a haemorrhagic left frontal basal contusion and a small subarachnoid haemorrhage; a mediastinal haematoma with aortic dissection, left pneumothorax and right lung contusion; retroperitoneal haematoma with active bleeding from the left suprarenal artery and superior mesenteric artery; and a complex fracture-dislocation of the right hip (Fig. 2a-d).
Postoperative x-ray. Left thoracotomy was performed to repair the aortic dissection. Bilateral clavicle fracture
11751_2009_78_Fig3_HTML.jpg
PMC2839317_01_11751_2009_78_Fig3_HTML.jpg
Fig3
Scientific, NJ, USA) (Fig. 3). Supracondylar skeletal traction was applied as initial management of the hip injury whilst the patient received intensive supportive care.
Postoperative hip x-ray. Anteroposterior view
11751_2009_78_Fig4_HTML.jpg
PMC2839317_01_11751_2009_78_Fig4_HTML.jpg
Fig4
A 5-mm suture anchor (Twinfix, Smith and Nephew, Andover, MA, USA) was used for reattachment of the rectus femoris muscle onto the anterior inferior iliac spine (Fig. 4).
Recurrent posterior dislocation of the hip despite use of an abduction orthosis
11751_2009_78_Fig5_HTML.jpg
PMC2839317_01_11751_2009_78_Fig5_HTML.jpg
Fig5
An abduction orthosis was used to maintain joint reduction, but 4 days later, a further recurrent dislocation was diagnosed (Fig. 5).
Steinmann pin across greater trochanter into the acetabulum and supracondylar skeletal traction were used to maintain reduction
11751_2009_78_Fig6_HTML.jpg
PMC2839317_01_11751_2009_78_Fig6_HTML.jpg
Fig6
Closed reduction was performed but stability in reduction was not achieved; a trans-articular Steinmann pin, across the greater trochanter into the acetabulum, with additional supracondylar skeletal traction was used to maintain reduction (Fig. 6).
Three-months follow-up. X-ray showing heterotopic ossification without avascular necrosis of the femoral head
11751_2009_78_Fig7_HTML.jpg
PMC2839317_01_11751_2009_78_Fig7_HTML.jpg
Fig7
Radiographs at this stage showed early heterotopic ossification (Fig. 7).
Final radiograph shows healed fractures and heterotopic ossification
11751_2009_78_Fig8_HTML.jpg
PMC2839317_01_11751_2009_78_Fig8_HTML.jpg
Fig8
At 18-months, the fractures were healed (Fig. 8).