Rare combination of ipsilateral acetabular fracture-dislocation and pertrochanteric fracture.
Acetabular fracture-dislocations are severe injuries that require urgent closed reduction of the hip and often require surgery to restore hip stability. Other authors have described acetabular fracture-dislocations associated with femoral neck fractures, but to our knowledge, this case report is the first to describe an acetabular fracture-dislocation in association with an ipsilateral pertrochanteric fracture and subtrochanteric extension. The polytraumatized patient initially was not stable enough for prolonged surgery. Through a 3-cm anterolateral hip incision, a 5-mm Schanz screw was introduced percutaneously into the femoral head through the primary fracture site under fluoroscopic guidance. With inline traction on the leg, the Schanz screw was used to manipulate the femoral head back into the acetabular fossa. The Schanz screw was removed, the head remained reduced, and a skeletal traction pin was placed to maintain length and alignment of the pertrochanteric fracture until definitive stabilization was possible. We propose a staged treatment strategy consisting of early closed reduction of the hip, and after the patient has been stabilized, reduction and fixation of the fractures. This strategy may be useful in managing an unstable polytraumatized patient or a patient who requires prolonged transfer to receive definitive care.
Director, Orthopedic Trauma, Department of Orthopaedic Surgery, United States Naval Medical Center San Diego, California. kevin.kuhn@med.navy.mil.
Kevin M
KM
Kuhn
John A
JA
Boudreau
J T
JT
Watson
D000063:Accidents, Traffic; D000077:Acetabulum / Q000293:injuries*; D000328:Adult; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006617:Hip Dislocation / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006620:Hip Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D011859:Radiography