PMC9050324_01
(a) Injury radiographs and selected (b) axial, ((c) 1-3) sagittal, and ((d), 1-4) coronal computed tomography cuts demonstrating displaced right capital femoral epiphysis and posterior fracture-dislocation of right hip with posterior column acetabular fracture.
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Radiographs and computed tomography (CT) of the pelvis and right femur (Figure 1) showed a posteriorly dislocated Delbet type Ib right capital femoral epiphyseal separation and a fracture of the right acetabulum through the triradiate cartilage, posterior column, and posterior wall.
Three-dimensional CT reconstruction images demonstrating the displaced right capital femoral epiphysis and disrupted right acetabular posterior column.
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CT reconstruction images are shown in Figure 2. Closed reduction of the fracture-dislocation was not attempted in the emergency department due to the concern of further disruption of the blood supply to the capital femoral epiphysis.
Intraoperative AP and lateral fluoroscopy views demonstrating the reduced right hip joint and fixation of right capital femoral epiphysis.
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The reduced capital epiphysis was percutaneously stabilized with two 6.5 mm cannulated screws (Figure 3).
Postoperative AP and Judet pelvis radiographs demonstrating the fixation of right acetabulum and concentric reduction of right femoral head.
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The patient then returned to the operating room on hospital day two for open reduction and internal fixation of the right acetabulum (Figure 4) via a Kocher-Langenbeck approach under the direction of an orthopaedic traumatologist (D.E.A.) using a 1-hole spring plate, two 3.5 mm reconstruction plate, and 3.5 mm bicortical position screws.
(a) AP and (b) lateral plain radiographs taken two months after fixation demonstrating the maintenance of reduction and fixation and no evidence of femoral head collapse.
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Radiographs (Figure 5) revealed maintenance of fixation with concentric reduction of the right femoral head and maintenance of reduction of the displaced capital femoral epiphysis.
(a) AP and (b) Judet pelvis radiographs and (c) AP and lateral right hip radiographs taken 22 months after the fixation demonstrating interval healing of the right acetabulum and proximal femur, maintenance of joint space and concentricity, and no evidence of avascular necrosis. The two femoral neck screws have been broken since prior radiographic evaluation, and there is a varus malunion of the right proximal femoral physeal separation.
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Radiographs (Figure 6) revealed a healed right acetabulum and right proximal femur with interval physeal closure, preserved joint space, concentrically reduced spherical femoral head, and no evidence of avascular necrosis, confirmed upon review by our institutional board-certified musculoskeletal radiologist.