Combined acetabular and femoral neck fractures with intrapelvic femoral head dislocation: Successful staged management of a rare injury in two cases

Abstract

Combined central acetabular and femoral neck fractures with intrapelvic femoral head dislocation is an infrequent situation that provides a problematic condition for surgeons attempting to reconstruct the hip joint. Herein, we report two cases involving central acetabular fracture-dislocation combined with intrapelvic dislocation of a fractured femoral neck. Each case involved associated injuries that made primary total hip arthroplasty (THA) impossible and necessitated using the fewest skin incisions possible. As a result, we first attempted a posterior acetabular fixation of both the anterior and posterior columns with intra-articular plating of the anterior column. Finally, a cementless acetabular cup was implanted. There were no complications identified during the stages of reconstruction up to and including THA. The two patients̓ final Harris Hip scores were 98 for the first patient (at five years), and 91 for the second patient (at 1 ½ years). In conclusion, staged reconstruction of the hip joint with intra-articular acetabular plating does not weaken the acetabular bone that can accept insertion of THA with cementless biological acetabular fixation without complications and with an acceptable clinical outcome up to five years.

Figure 1. X-ray and computed tomography views of the fractures. (a) Anteroposterior X-ray view of the pelvis. (b) Coronal computed tomography cuts. (c) Axial computed tomography cuts.

Figure 2. Images of the fixation of the acetabular columns. (a) An intraoperative image showing the intraarticular fixation of the anterior column by 3.5-mm reconstruction plate (thick arrow). (b) An intraoperative image showing the 4.5-mm plate for the posterior column (thin arrow) and the 3.5-mm plate for the anterior column (thick arrow). (c) Postoperative X-ray views after fixation of the acetabular fractures. Black arrow points to the intraarticular plating.

Figure 3. Postoperative X-ray showing the cementless total hip arthroplasty. (a) Immediate postoperative X-ray view. (b) Following a five-year follow-up.

Figure 4. X-ray and computed tomography views of the fractures. (a) Anteroposterior X-ray view of the pelvis. (b) Threedimensional reconstruction CT cuts.

Figure 5. Images of the fixation of the acetabular columns. (a) Postoperative X-ray views after fixation of the acetabular fractures. Thick arrows point to the intra-articular anterior plate and thin arrows to the posterior plates. (b) An intra-operative image showing the 4.5-mm plate for the posterior column (thin arrow) and the 3.5-mm plate for the anterior column (thick arrow).

Figure 6. Postoperative X-ray showing the total hip arthroplasty. (a) Immediate postoperative X-ray view. (b) Following an 18-month follow-up.