PMC6159191_01
Anterior-posterior X-ray pelvis view, preinterventional, showing clearly the posterior dislocation of the right hip joint, and no visible fracture lines.
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A CT scan of the hip was performed afterwards (Figures 1, 2), indicating an acetabular fracture line without any dislocation and consequently needing no further surgical treatment.
Native CT scans of the hip, postinterventional control: (a) coronal view, (b,c) axial views. (a) Impression fracture of the fovea of the femoral head. (b) Impression fracture of the fovea of the femoral head, fracture line in the posterior column of the acetabulum. (c) Fracture line in the posterior column of the acetabulum.
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A CT scan of the hip was performed afterwards (Figures 1, 2), indicating an acetabular fracture line without any dislocation and consequently needing no further surgical treatment.
T1 MRI scans, 1 month post trauma, (a, e) coronal short tau inversion recovery sequences, (b, d) axial turbo spin-echo sequence, (c, f) axial short tau inversion recovery sequences. Regular anatomical positioning of the femoral head in the acetabulum, soft tissue oedema in the region of the posterior and inferior periarticular muscles, seen as hyperintensive signal on T2-weighted images (a, b) retracted muscle belly of the superior gemellus muscle, (c) internal obturator muscle tendon with effusion in the subjacent bursa, (d) tissue oedema in the muscle belly of the external obturator muscle, (e) tissue oedema around the quadratus femoris, (f) small crescent-shaped fissure within the femoral head. No signs of abnormalities of the piriformis muscle, the tensor fascia latae muscle and the gluteal muscles could be detected; there was no fracture of the acetabulum and no signs of intraarticular joint effusion.
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On the images (Figure 3), the articulation of the femoral head within the acetabulum was congruent. The origin of the superior gemellus muscle was not visible, the muscle belly being retracted and thickened (Figure 3a,b). The obturator internus muscle tendon was surrounded by moderate effusion in the subjacent bursa (Figure 3c). The tendons of the inferior gemellus, the quadratus femoris and the external obturator muscles were normal; there was however severe tissue oedema in the muscle bellies of the quadratus femoris (Figure 3d) and the external obturator muscles (Figure 3e).
MRI scans, 19 months post trauma, (a, d, e) coronal turbo spin echo proton density sequence, (b, c, f) axial turbo inversion recovery magnitude sequences. (a, b) undulated shape of the tendon gemellus superior muscle, (c) partial rupture of the internal obturator muscle, different than the results from the first MRI scan, (d) scarring in the region of the quadratus femoris muscle, (e) hypertrophy of the piriformis muscle, (f) scarring of the femoral head.
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The follow-up MRI (Figure 4) showed an undulated shape of the tendon of the superior gemellus muscle (Figure 4 a,b). Although the obturator muscle itself was without pathology in the first MRI, it now was partially ruptured (Figure 4c). There was some scarring around the quadratus femoris muscle (Figure 4d). Scarring of the femoral head was present (Figure 4f). Additionally, we detected hypertrophy of the piriformis muscle (Figure 4e), which was without pathological findings in the first MRI report.