Presentation
Motor vehicle collision.
Patient Data
The left femur is adducted and internally rotated.
Posterior dislocation of the left femoral head fixed in position by the posterior margin of the acetabulum.
Moderate lipohemarthrosis is seen filling the acetabular cavity, with three layering densities.
Intra-articular loose osseous bodies are noted.
Displaced bone fragments of the fractured posterior acetabular lip.
Pelvis - post closed reduction
Reduction was done in ER under conscious sedation with Midazolam.
Left femoral head is in place with remaining two fractured bone fragments from posterior acetabular rim posterior to iliac bones.
The intra-articular loose osseous body is still noted near fovea capitis.
Mild left hip effusion is noted.
Post open fixation with plate and screws through posterior access was done.
Case Discussion
This is an example of left femoral head posterior dislocation with fractured posterior acetabular rim, intra-articular bony fragments and lipohemarthrosis.
Posterior dislocation of the hip joint is much more common than anterior dislocation and is mainly caused by forceful trauma like dashboard injury in vehicle collisions and falls from height.
After reduction of the dislocation, it is important to remove intra-articular bone fragments and assess acetabular rim and column fractures. Fixation of acetabular fractures is important to prevent recurrent dislocation and reduction is important to avoid sciatic nerve injury.
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