J Korean Orthop Assoc.  2014 Apr;49(2):153-158. 10.4055/jkoa.2014.49.2.153.

Posttraumatic Osteonecrosis of the Femoral Head after Nine Years of Posterior Femoral Head Fracture Dislocation

• Park KS
• Yoon TR
• Haq RU

• KMID: 2185221
• DOI: http://doi.org/10.4055/jkoa.2014.49.2.153

Abstract

Posttraumatic osteonecrosis of the femoral head (ONFH) is the most serious complication after fracture dislocation of the femoral head. The rate of this complication was reported to range from 1.7% to 40%. Although the development of posttraumatic osteonecrosis normally occurs within 2 years of injury, there are some reports of the late development ONFH. The authors encountered a case of posttraumatic ONFH that developed after 9 years of a Pipkin type I fracture dislocation. The patient was treated by modified transtrochanteric rotational osteotomy. We report this rare case with a review of the relevant literatures.

Keyword

femoral head; posttraumatic osteonecrosis; fracture dislocation; transtrochanteric rotational osteotomy

MeSH Terms

Dislocations*
Head*
Humans
Osteonecrosis*
Osteotomy

Figure

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  Figure 1 (A) Anteroposterior radiograph of both hips show a Pipkin type I fracture dislocation. (B) Radiograph taken after a closed reduction. (C) Computed tomography scan of the left hip after reduction shows a large anterior bony fragment. (D) Intraoperative photograph shows a relatively large fragment involving the anteroinferior portion of the femoral head. (E) Intraoperative photograph after fixation of the fragment. (F) Radiograph taken after open reduction and fixation with three-screws.

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  Figure 2 Anteroposterior (A) and femoral head lateral (B) radiographs taken 9 years after injury show good maintenance of the joint space and bony union without subchondral fracture or other sign of osteonecrosis of the femoral head. T1-weighted magnetic resonance imagimg axial (C) and coronal (D) view show a small region of the osteonecrosis anteriosuperior of the femoral head (white arrows).

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  Figure 3 Immediate postoperative anteroposter ior (A) and lateral (B) radiographs of both hips show the osteomy site fixed with two cannulated screws. The last follow-up anteroposterior (C) and lateral radiographs (D) taken 3 years after the rotational osteotomy show good bony union.

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  Figure 4 Clinical photographs of the patient at the last follow-up demonstrate that she is able to sit cross-legged (A) and squat (B) without limitation.

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