Obturator Dislocation of the Hip with Associated Femoral Head Impaction and Medial Wall Fracture of the Acetabulum.

Introduction

The combination of traumatic obturator dislocations and a femoral head impaction is rare and the treatment challenging. This report describes the successful management of this rare injury in a young patient.

Case Report

A 22-year-old truck driver involved in a ski accident sustained an obturator dislocation of the right hip associated with a femoral head impaction in the weight-bearing zone and a medial wall fracture of the acetabulum. After an initial closed reduction within 6 hours after the accident, for the definitive treatment, the hip joint was exposed through a Kocher-Langenbeck approach with trochanter flip osteotomy and surgical hip dislocation. A closing wedge intertrochanteric osteotomy was performed aiming to turn the head impaction out of the weight-bearing zone and the large head defect filled with the bone block removed from the osteotomy. The medial wall fragment was fixed, and the graft and osteotomies were stabilized with screws and a blade plate. The patient was mobilized with partial weight-bearing for 3 months then he progressively started full weight-bearing and normal daily activities. 5 years after the injury, the patient was completely asymptomatic, and radiographs demonstrated union of all osteotomies, osseous integration and remodeling of the bone graft as well as correct congruity of the hip joint.

Conclusion

The intertrochanteric osteotomy aims to turn the impacted zone out of the weight-bearing area. Bone grafting of the defect helps to restore congruence and containment of the hip and additionally reinforces the femoral neck. To manage all the lesions present, a trochanteric flip approach with surgical hip dislocation is mandatory.