Abstract
Femoral head fracture-dislocations are rare, and irreducible cases are even less frequent. Truly irreducible fracture-dislocations must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. The Pipkin classification is commonly used to classify femoral head fractures. An urgent reduction is required in traumatic hip dislocations to reduce the risk of avascular necrosis (AVN) of the femoral head. However, in femoral head fractures, the dislocated hip cannot be reduced easily due to incarcerated bone or soft tissue. In an irreducible fracture hip dislocation, It is not advisable to attempt to reduce it repeatedly because sometimes femoral head fracture-dislocation is associated with the impacted fracture of the femoral neck. It may lead to iatrogenic femoral neck fracture. Hence, in such cases, immediate open reduction and internal fixation are recommended. The Kocher-Langenbeck approach can be used for reduction and safe surgical dislocation with flip trochanteric osteotomy for fixation as a novel approach.
Highlights
The incidence of femoral head fracture-dislocation is between 8-26% [1]
The Kocher-Langenbeck approach can be used for reduction and safe surgical dislocation with flip trochanteric osteotomy for fixation as a novel approach
Necessary imaging procedures like X-ray and CT scan should be done before the reduction attempt as there is always an increased risk of the iatrogenic neck of femur fracture after a closed reduction [8]
Summary
The incidence of femoral head fracture-dislocation is between 8-26% [1]. it is clear that femoral head fracture-dislocation is a rare condition [2], and dislocations that cannot be reduced by the close method is even rarer [3,4]. The most common cause is high-energy road traffic accidents with associated injuries of the ipsilateral knee, acetabulum, femoral neck, sciatic nerve, and pelvis. Necessary imaging procedures like X-ray and CT scan should be done before the reduction attempt as there is always an increased risk of the iatrogenic neck of femur fracture after a closed reduction [8]. True irreducible fracture-dislocations are where the femoral head cannot be reinserted into the acetabulum, and they must be differentiated from incomplete reduction caused by the femoral head fragment or soft tissue interposition. It remains controversial as to which treatment approach should be used in such cases [9]. We used the extended Kocher-Langenbeck approach with a flip trochanteric osteotomy to treat the irreducible femoral head fracture-dislocation
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