title: Surgical hip dislocation for osteochondral transplantation as a salvage procedure for a femoral head impaction fracture.
abstract: Obturator anterior hip dislocation is very rare. Poor results are described in patients with additional large transchondral fractures and treatment of these injuries remains challenging. Appropriate treatment recommendations are missing in the literature. This case report introduces surgical hip dislocation for osteochondral autograft transplantation with graft harvest from the nonweightbearing area of the head-neck junction as a salvage procedure in a large femoral head defect. We report the treatment and outcome of a 48-year-old man who sustained an anterior dislocation of the left hip after a motorcycle accident. After initial closed reduction in the emergency room, imaging analysis revealed a large osteochondral defect of the femoral head within the weightbearing area (10 × 20 mm, depth: 5 mm). The hip was exposed with a surgical hip dislocation using a trochanteric osteotomy. An osteochondral autograft was harvested from a nonweightbearing area of the femoral head and transferred into the defect. The patient was prospectively examined clinically and radiologically. Two years postoperatively, the patient was free of pain and complaints. The function of the injured hip was comparable to that of the contralateral, healthy hip and showed satisfying radiologic results. Surgical hip dislocation with a trochanteric flip osteotomy is a simple, one-step technique that allows full inspection of the hip to treat osteochondral femoral defects by osteochondral transplantation. The presented technique, used as a salvage procedure in a large femoral head defect, yielded good clinical and satisfying radiologic outcomes at the midterm.
authors.affiliation: Department of Orthopedic Surgery, University of Bern, Inselspital, Bern, Switzerland. johannesbastian@gmx.de
authors.forename: Johannes Dominik
authors.initials: JD
authors.lastname: Bastian
authors.forename: Lorenz
authors.initials: L
authors.lastname: Büchler
authors.forename: Dominik Christoph
authors.initials: DC
authors.lastname: Meyer
authors.forename: Klaus Arno
authors.initials: KA
authors.lastname: Siebenrock
authors.forename: Marius Johann
authors.initials: MJ
authors.lastname: Keel
authors.forename: Marius Johann Baptist
authors.initials: MJ
authors.lastname: Keel
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005270:Femur Head / Q000000981:diagnostic imaging / Q000293:injuries*; D006617:Hip Dislocation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome