Traumatic Obturator Dislocation of the Hip Joint Associated with Greater Trochanter Fracture: A Case Report

Abstract

Background: Traumatic obturator dislocation of the hip joint associated with greater trochanter fracture is a rare injury. We used the lateral approach through the rectus abdominis to remove the femoral head dislocated into the obturator, and the posterolateral approach was used for reduction and internal fixation of the femoral greater trochanteric fracture and total hip replacement (THR). Good follow-up results were achieved. To the best of our knowledge, this is the first report on this particular type of injury and on this approach to treating this type of injury. Case Report: The patient was hospitalized due to a traffic accident that resulted in the patient experiencing swelling and deformity accompanied by limited mobility of the left hip and left knee. X-ray examination and CT confirmed that the patient suffered from left hip obturator dislocation, greater trochanter fracture, pelvic fracture (Tile B), left acetabular fracture, right open tibiofibular comminuted fracture (Gustilo III), and posterior urethral injury. The femoral head was removed from the pelvic cavity through a pararectus approach under general anesthesia. A posterolateral approach was used for open reduction, and cable internal fixation for the left intertrochanteric fracture and uncemented THR were performed. Results: The ability to work was restored 6 months after the operation. The Harris hip score, reflecting joint function, was 86 points after 2 years of follow-up observation. Conclusion: A lateral approach of rectus abdominis to remove the dislocated femoral head in the pelvis from the obturator should be selected, along with the posterolateral approach for reduction and internal fixation of the intertrochanteric fracture and THR. This case also provides a new reference for the treatment of this type of hip fracture dislocation.

Traumatic obturator dislocation of the hip joint: About 2 cases and review of the literature

“…It's a therapeutic emergency that often requires a reduction of the dislocation, by external manoeuvres, under anaesthesia in good conditions. Sometimes, the presence of associated lesions, specifically, fracture of the femoral head or the femoral neck, or due to fragmentary incarceration, makes the dislocation irreducible and requires a surgical approach to reduce and synthesise [2] , [10] , [11] , [12] , [13] , [14] , [15] . It's a serious lesion because it involves the prognosis of the femoral head in the medium and long term with the main complications dominated by the risk of osteoarthritis and post-traumatic necrosis.…”