Osteochondral Autograft from the Ipsilateral Femoral Head by Surgical Dislocation for Treatment of Femoral Head Fracture Dislocation: A Case Report

Abstract

As anatomical reduction of the articular surface of femoral head fractures and restoration of damaged cartilage are essential for good long-term results, many treatment options have been suggested, including fixation of the fracture using various surgical exposures and implants, as well as arthroscopic irrigation and debridement, bone marrow stimulating techniques, osteochondral allograft, autograft, and autogenous chondrocyte implantation. We report a case of osteochondral autograft harvested from its own femoral articular surface through surgical hip dislocation. The osteochondral graft was harvested from the inferior non-weight-bearing articular surface and grafted to the osteochondral defect. One year later, the clinical and radiological results were good, without the collapse of the femoral head or arthritic change. This procedure introduced in our case is considered convenient and able to lessen surgical time without morbidity of the donor site associated with the harvest.

Keywords: Femoral head; autograft transplant; fractures cartilage; hip dislocation.

Fig. 1. (A) Plain radiograph showing femoral head fracture. (B and C) CT scan showing Pipkin type II femoral head fracture. (D) CT sagittal scan show femoral defect of weight bearing portion.

Fig. 2. (A) 2.5×1 cm femoral head defect is visible after fixation of the main fragment. (B) OATS was performed with a bone plug harvested from the inferior non-weight bearing portion of the affected femoral head. (C) OATS was performed using a headless 3.5 mm compression screw. OATS, osteochondral autologous graft transplantation surgery.

Fig. 3. (A and B) One year after the operation, plain radiograph and CT scan shows good fixation and articulation. (C) Arthroscopic findings one year after the operation show mild fraying and softening, but the overall surface was regenerated with fibrocartilage tissue.