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Case Report Femoral Head Fracture with Hip Dislocation Treated by Autologous Osteochondral Transfer (Mosaicplasty) - A Case Report -
Eui-Sung Choi, Hyun-Chul Shon, Ho-Seung Jeong, Jae-Young Yang, Seok-Hyun Hong, Byung-Hyun Ahn
Journal of Musculoskeletal Trauma 2020;33(2):96-100.
DOI: https://doi.org/10.12671/jkfs.2020.33.2.96
Published online: April 30, 2020
Department of Orthopedic Surgery, Chungbuk National University College of Medicine, Cheongju, Korea

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Abstract

Femoral head fractures combined with hip dislocation are very rare injuries. In most cases, they result from high-energy trauma to the hip or lower extremity during traffic accidents. Various therapy options have been suggested to treat these injuries. Especially, different joint-preserving surgical options have been described for the treatment of traumatic osteochondral injury of the femoral head in young, active patients. In this report, we present a case that a traumatic osteochondral lesion to the femoral head after hip dislocation was treated with osteochondral autografts (OATS) from the non-weight-bearing area of the ipsilateral inferior femoral head through a surgical hip dislocation. After 1 year, the clinical and radiological outcome was satisfactory with no evidence of posttraumatic osteoarthritis and no pain of patients.


J Korean Fract Soc. 2020 Apr;33(2):96-100. Korean.
Published online Apr 28, 2020.
https://doi.org/10.12671/jkfs.2020.33.2.96
Copyright © 2020 The Korean Fracture Society. All rights reserved.
Case Report

Femoral Head Fracture with Hip Dislocation Treated by Autologous Osteochondral Transfer (Mosaicplasty): A Case Report

Eui-Sung Choi, M.D., Ph.D., Hyun-Chul Shon, M.D., Ph.D., Ho-Seung Jeong, M.D., Jae-Young Yang, M.D., Seok-Hyun Hong, M.D. and Byung-Hyun Ahn, M.D.
    • Department of Orthopedic Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.
  • Correspondence to: Hyun-Chul Shon, M.D., Ph.D. Department of Orthopedic Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 776, 1sunhwan-ro, Seowon-gu, Cheongju 28644, Korea. Tel: +82-43-269-6077, Fax: +82-43-274-8719, Email: hyunchuls@chungbuk.ac.kr
Received December 10, 2019; Revised January 07, 2020; Accepted March 16, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Femoral head fractures combined with hip dislocation are very rare injuries. In most cases, they result from high-energy trauma to the hip or lower extremity during traffic accidents. Various therapy options have been suggested to treat these injuries. Especially, different joint-preserving surgical options have been described for the treatment of traumatic osteochondral injury of the femoral head in young, active patients. In this report, we present a case that a traumatic osteochondral lesion to the femoral head after hip dislocation was treated with osteochondral autografts (OATS) from the non-weight-bearing area of the ipsilateral inferior femoral head through a surgical hip dislocation. After 1 year, the clinical and radiological outcome was satisfactory with no evidence of posttraumatic osteoarthritis and no pain of patients.

Keywords
Femoral head fracture, OATS, Fracture-dislocation

Figures

Fig. 1
(A) Anteroposterior Hip radiograph shows left femoral head fracture. (B) Axial computed tomography image shows a left hip posterior dislocation with Pipkin type II femoral head fracture.

Fig. 2
(A) Postreduction axial computed tomography (CT) image shows a correct position of the femoral head. (B) Postreduction coronal CT scan shows a defect of the anterior-superior weight bearing dome of the femoral head.

Fig. 3
(A) An intraoperative image of the femoral head after a surgical hip dislocation. (B) An intraoperative image showing placement of Acutrak (Acuemd) for fixation of the main fragment after anatomical reduction. A large osteochondral defect in the weight-bearing surface of the femoral head is visible.

Fig. 4
(A) An intraoperative image showing harvesting 10-mm-diameter two osteochondral plugs from the inferior non-weight-bearing surface. (B) Final image showing a smooth contour after insertion of the donor plugs and greater trochanter autograft.

Fig. 5
(A) One year follow-up plain radiograph shows no evidence of the collapse of femoral head. (B) Coronal computed tomography image at 1 year postoperatively, showing no evidence of posttraumatic osteoarthritis or the collapse of femoral head.

Notes

Financial support:None.

Conflict of interests:None.

References

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    1. Kim JW, Kim JH. Updates on treatment of femoral head fractures. J Korean Orthop Assoc 2015;50:171–177.
    1. Massè A, Aprato A, Alluto C, Favuto M, Ganz R. Surgical hip dislocation is a reliable approach for treatment of femoral head fractures. Clin Orthop Relat Res 2015;473:3744–3751.
    1. Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001;83:1119–1124.
    1. Hangody L, Füles P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am 2003;85-A Suppl 2:25–32.
    1. El Bitar YF, Lindner D, Jackson TJ, Domb BG. Joint-preserving surgical options for management of chondral injuries of the hip. J Am Acad Orthop Surg 2014;22:46–56.
    1. Hart R, Janecek M, Visna P, Bucek P, Kocis J. Mosaicplasty for the treatment of femoral head defect after incorrect resorbable screw insertion. Arthroscopy 2003;19:E1–E5.
    1. Nam D, Shindle MK, Buly RL, Kelly BT, Lorich DG. Traumatic osteochondral injury of the femoral head treated by mosaicplasty: a report of two cases. HSS J 2010;6:228–234.
    1. Girard J, Roumazeille T, Sakr M, Migaud H. Osteochondral mosaicplasty of the femoral head. Hip Int 2011;21:542–548.
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    Femoral Head Fracture with Hip Dislocation Treated by Autologous Osteochondral Transfer (Mosaicplasty) - A Case Report -
    J Korean Fract Soc. 2020;33(2):96-100.   Published online April 30, 2020
    DOI: https://doi.org/10.12671/jkfs.2020.33.2.96
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