* Fawzi Boutayeb, # Saïd Boujraf, ж Lotfi Ameziane

*Department of Orthopedic and Traumatic Surgery, University Hospital Hassan II, Fez 30000, Morocco
#Department of Biophysics and Clinical MRI Methods, Faculty of Medicine and Pharmacy, University of Fez, Fez 30000, Morocco
жDepartment of Orthopedic and Traumatic Surgery, University Hospital Chieck Zayd, Rabat 10000, Morocco

Address for Correspondence
Prof. Fawzi Boutayeb,
Department of Orthopedic and Traumatic Surgery,
Al Ghassani Hospital, University Hospital Hassan II, Fez 30000; Morocco
Phone: 00 212 61 480 022, Fax: 00 212 55 941 364
E-Mail: boutayeb_fawzi@yahoo.fr

Abstract

The association of a femoral neck fracture and a fracture of the acetabulum without hip dislocation is an exceptional lesion. We report such lesion which was treated by a total prothesis of cemented hip.
Key Words: Femoral Neck fracture, Acetabulum Fracture, Hip dislocation Fracture, Total Hip Arthroplasty (THA)

J.Orthopaedics 2006;3(4)e13

Introduction:

The femoral neck fracture associated to transversal cotyle without dislocation of the hip is a rare lesion, but it has a severe gravity (1). It involves the functional prognosis of the hip. In this paper, we report such lesion which was treated by a total arthroplasty of cemented hip, and we discuss the physiopathologic aspects as well as the therapeutic attributes.

Material and Methods :

Case Report

Our patient is male of sixty year old; he was admitted at the department of traumatology and orthopedics surgery of the University Hospital Hassan II in April 2004. He was transferred from a regional hospital for treating a multiple fractures following an accident that happened on the public road. The radiography showed a comminuted epiphyseal fracture of the left radius and a fracture of the right femoral neck Garden IV, associated to a transverse acetabulum fracture without dislocation of the left hip (Figure 1). The fracture of the wrist embranchment was achieved 48 hours after hospitalization, this was done under locoregional anesthesia. A traction-suspension was set during four weeks of fractures of the hip. Then we realized a total arthroplasty of hip cemented without any difficulty (Figure 2). A recession of 18 months showed a patient a good functional result.

Discussion :

The fracture of the femoral neck associated to cotyle fracture without dislocation of the hip, is an exceptional lesion. Only too few cases were reported in the literature (1-5). Khalily et al reported a case of bilateral pathologic fracture of the neck and ipsilateral acetabulum (6).

In contrast, an association of the femoral neck fracture to dislocation fracture of the hip (fracture of the posterior wall of acetabulum) is a not frequent lesion (7-9). The dislocation is caused by an axial force of compression combined with adduction (9). If the longitudinal forces are stronger than the adduction forces, the acetabulum fracture is yielded. Given that the head is fixed by the round ligament and if adduction forces are important, a fracture of the femoral neck is produced. Meller et al (10) considered that there is an effect of “coup” and “contrecoup” in the production of the femoral neck fracture. Klasen (7) reports two cases of young patients which presented a posterior dislocation fracture (acetabulum’s posterior wall) associated to a femoral neck fracture; this was treated by double compressive screwing for the fracture of the collar, and a screwing of the posterior wall. The treatment of choice of the young subject consists of an anatomical reduction of fractures and a stable synthesis which are essential conditions for a good consolidation. The total arthroplasty of hip will be suggested in secondarily terms at the stage of post-traumatic degenerative osteoarthritis, this approves any defect of reduction of the cotyle fracture, and also after the femoral head necrosis. In the case of our patient, regarding his age and his general state, we preferred to implant at once a total prothesis of cemented hip. This was for avoiding a substantial surgery of the both fractured lesions and prolonged discharge; therefore allowing an immediate functional recovery.

Conclusion:

The cotyle fracture associated to a fracture of the homolateral femoral neck is an extremely rare lesion. An anatomical reduction of both lesions with solid synthesis is the logical attitude for obtaining the consolidation. Nevertheless, the price is a surgery which is not always uncomplicated. The total arthroplasty of hip is also a valid therapeutic option for old subjects. It allows treating both, lesions and with an immediate functional recovery.

Reference :

1. Mestdagh H, Butruille Y, Vigier P. Central fracture- dislocation of the hip with ipsilateral femoral neck .Case report. J Trauma 1991; 31: 1445 -7

2. Higgs R J, Newman A S. Central acetabular fracture with ipsilateral displaced fracture of the femoral neck. Aus N Z J Surg 1993; 63; 828-30.

3. Hertlein H , Mittlmeier T , Schurman M, Lob G.Acetabulum fracture with central hip dislocation and ipsilateral femoral neck fracture in epileptic seizure. Chirurg 1991; 62;429-31.

4. Meinhard BP, Misoul C, Joy D, Ghillani R. Central acetabular fracture with ipsilateral femoral neck fracture and intrapelvic dislocation of the femoral head without major pelvic- columnn disparution. A case report. J B J S Am 1987; 69; 612-5.

5. Mann C F, Rebollo M I. Femoral neck fracture complicating a missed acetabular fracture in an elderly patient. Injury 1988; 29; 75-76.

6. Khalily C, Ilizaliturri VM Jr, Lester DK. Bilaterale pathologic fractures of the hip and acétabulum treated with cementless total hip arthroplasty. J Arthroplasty. 2002; 17; 664-6.

7. Klasen H J, Binnendi J K. Fracture of the neck of the femur associated with posterior dislocation of the hip. J B J S Br 1984; 66-B(1).

8. Hougaard K, Thomsen P B. Traumatic posterior fracture- dislocation of the hip with fracture of the femoral head or neck, or both. J B J S Am 1988; 70; 223- 239.

9. Fernandes A, Traumatic posterior dislocation of the hip joint with a fracture of the head and neck of the femur on the same side. A case report. Injury 1980; 12; 487-90.

10. Meller Y, Tennenbaum Y, Torok G. Subcapital fracture of neck of femur with complete posterior dislocation of the hip . J Trauma 1982; 22; 327-9.

This is a peer reviewed paper 

Please cite as : Fawzi Boutayeb:Femoral Neck Fracture Associated To Homolateral Cotyle Treated By Cemented Hip Total Arthroplasty

J.Orthopaedics 2006;3(4)e13

URL: http://www.jortho.org/2006/3/4/e13

ANNOUNCEMENTS

Powered by
VirtualMedOnline