Surgical dislocation of the femoral head for joint debridement and accurate reduction of fractures of the acetabulum

Abstract

Objectives: To evaluate fracture reduction, femoral head viability, and outcome of selected acetabular fractures treated operatively using a modified Kocher-Langenbeck approach with a trochanteric flip osteotomy and surgical dislocation of the femoral head.

Design: Prospective.

Patients: Twelve patients predominantly with combined transverse and posterior wall fractures or multifragmentary posterior wall fractures. OUTCOME EVALUATION: Clinical and radiographic analysis after a minimum 2-year follow-up.

Methods: A single modified approach, including anterior ( = 8) or posterior ( = 4) surgical dislocation of the femoral head, was done in 12 patients for one or more of following reasons: intra-articular assessment of reduction in fractures with comminution, marginal impaction and involvement of the anterior column, removal of intra-articular fragments, and confirmation of extra-articular screw placement.

Results: At a mean follow-up of 35 months (24-48 months), the 12 patients presented with a good to excellent clinical result according to the D'Aubigné score. One patient developed postoperative osteoarthritic changes after an imperfect reduction. No heterotopic ossification interfering with hip function was found. None of the hip joints developed signs of avascular necrosis of the femoral head, even though seven patients sustained a posterior dislocation at time of the injury.

Conclusion: This study indicates that this technique for surgical dislocation of the femoral head is safe and facilitates assessment of fracture reduction in selected acetabular fractures.