Femoral head fracture with large crushed defect in weight-bearing area treated with autologous osteochondral transplantation (repositionplasty): A case report

Abstract

Femoral head fracture is a rare type of fracture commonly associated with hip dislocation. Femoral head fracture treatments include conservative treatment, fragment excision, open reduction, internal fixation, and arthroplasty. In cases of young patients, open reduction and internal fixation are preferred over arthroplasty. Pipkin type 2 fractures are treated with open reduction and internal fixation in most cases because the fracture line extends upward of the fovea and includes the femoral head-acetabular weight-bearing joint surface. However, if the fracture is severely comminuted or crushed, good results are difficult to obtain with open reduction and internal fixation. A 23-years-old male patient presented to the emergency room with right hip pain after 4-m fall. In initial image work up, he was diagnosed with right posterior hip dislocation and a Pipkin type 2 femoral head fracture with an ipsilateral superior ramus fracture. After manual reduction, simple radiography and computed tomography showed reduction of the hip joint and a large osteochondral defect of approximately 6 cm2 in the weight-bearing area on the superomedial side of the femoral head. This was treated with a novel surgery named autologous osteochondral transplantation (repositionplasty), devised by the authors. The congruent reduction was confirmed by radiography and computed tomography immediately after the surgery. At 5 years postoperatively, the Harris Hip Score was 100 points and no discomfort, femoral head collapse, osteonecrosis, or traumatic arthritis were observed on follow-up radiographs. We think this method "repositionplasty" will be a good treatment method for young patients with a large defect in the weight-bearing part of the femoral head who cannot undergo open reduction and internal fixation.