A case of posterior HIP dislocation with intertrochanteric fracture: Beware of the sharp calcar spike

Abstract

Posterior dislocation of hip is commonly associated with acetabular lip fractures. Involvement of neck, trochanter or intertrochanteric region is uncommon. Very few cases of posterior hip dislocation with ipsilateral intertrochanteric fracture in the absence of head or acetabular fracture have been reported in the literature. We report such a case in a 19yr male treated with open reduction and internal fixation with sliding hip screw with good functional and radiological outcome at 1 year. Being an extremely rare form of injury, such an injury pattern does not exist in present classification systems. There is a need to revise the existing classification systems and formulate a protocol for the management of the same. Such fractures may also be associated with a sharp calcar spike of the proximal fragment impinging femoral vessels and branches. Attempt at closed reduction without adequate anatomical orientation of the spike can lead to hazardous vascular consequences.

Keywords: Classification; Intertrochanteric fracture; Open reduction internal fixation; Posterior dislocation hip.

Fig. 1

A) Preoperative anteroposterior radiograph showing right sided intertrochanteric femur fracture with hip dislocation and fracture of right sided superior pubic rami. B) Preoperative lateral radiograph showing the intertrochanteric femur fracture with head dislocated out of the acetabulum.

Fig. 2

a) 3d reconstruction CT scan image showing the Comminuted Intertrochanteric fragment with sharp anteriorly directed spike. b) Axial image of CT scan showing the posteriorly dislocated head with Calcar spike pointing anteriorly.

Fig. 3

Intraoperative photographs showing a) Femoral head buttoning out of through a small rent in the posterior hip capsuleand lying under the gluteus maximus. b) Reconstruction of the greater trochanteric using Stainless steel wire in Figure of 8 pattern.

Fig. 4

Intraoperative flurosccpic images: a) Provisional reduction and stabilization using 2 kirschner wires across the fracture site. b) Passage of the Reichert screw of the sliding hip srew system with 6.5mm derotation screw. c) Reconstruction of the fractured trochanter using stainless steel wire in figure of 8 pattern.

Fig. 5

a) Post operative anteroposterior radiograph: showing good reduction and fixation of the fractured fragments.b) Post operative Lateral radiograph showing good reduction.

Fig. 6

a and b: Post operative 6 month followup radiograph showing solid fracture union.

Fig. 7

A and b) Post operative 1 year followup radiographs showing no signs of Avascular necrosis.

Fig. 8

1 year followup Photographs a) Painless cross legged sitting b) Painless and comfortable Squatting.c) Good abductor strength and strong single leg stance.