Intrapelvic Dislocation of the Proximal Part of the Femur with Fracture of the Acetabulum: A Case Report.

Abstract

We present a case of a complex pelvic fracture with an intrapelvic dislocation of the proximal part of the femur. To our knowledge, there has been no previous report of a similar injury in an adult. This injury pattern does not readily fit into any of the commonly described classification systems. Although rare, this injury pattern requires early involvement of the pelvic trauma team and a high index of suspicion for concomitant visceral injuries. The patient was informed that data regarding the case would be submitted for publication, and he provided consent. A fifty-eight-year-old man was brought into the emergency department following an accident involving the left lower limb and pelvis. While trying to free the foot from a cattle grid, a car, which had an inadequately applied hand brake, rolled backward onto the left leg. Initial assessment showed that he was tachycardic but maintained his blood pressure and had a Glasgow Coma Score (GCS) of 15. On examination, the left leg was shortened and externally rotated. He had extensive tire-mark abrasions over the lateral aspect of the proximal part of the left thigh. Radiographs appeared to show an anteromedial dislocation of the left hip with a fracture of the left acetabulum and pubic ramus. Following abdominal and pelvic computed tomography (CT) scans, and in the temporary absence of the resident pelvic surgeon, the case was discussed with two pelvic trauma centers that advised that an attempt be made at closed reduction of the dislocation. The CT scan showed a complex pelvic fracture involving the sacrum and …