RESUMEN
UNLABELLED: Femoral head fracture-dislocations (FHFD) are rare, while irreducible cases are even less frequent. Truly irreducible fractures such as the two cases in this report must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. Opinions vary on the surgical approach to be used once the hip is reduced and the fragment of the femoral head yet remains to be stabilized. Reports in the literature do not usually take into account the specificity of irreducible lesions, which in our opinion should be treated by the transgluteal approach (TGA) while reducible forms can be treated by the Hueter approach. The transgluteal approach with the patient in the lateral decubitus position provides a direct anterior view of the antero-infero-medial fracture site as well as dorsal access via the injuries occasioned to dorsal soft tissues by the posterolateral dislocation. A lag screw can be used with this approach, which is the only way to stabilize the ligament teres femoris attachment. LEVEL OF EVIDENCE: Level IV retrospective historical study.
Asunto(s)
Cabeza Femoral/lesiones , Fijación Interna de Fracturas/métodos , Luxación de la Cadera/cirugía , Fracturas de Cadera/cirugía , Adulto , Artroplastia de Reemplazo de Cadera , Nalgas/cirugía , Femenino , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/etiología , Necrosis de la Cabeza Femoral/cirugía , Estudios de Seguimiento , Curación de Fractura/fisiología , Luxación de la Cadera/diagnóstico por imagen , Fracturas de Cadera/diagnóstico por imagen , Humanos , Masculino , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/etiología , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Radiografía , ReoperaciónRESUMEN
We report the case of a fracture of the glenoid, Goss-Ideberg type II, associated with an inferior dislocation of the shoulder, a combination that has not to our knowledge been previously reported. The injury had occurred after a fall of three metres. The radiological assessment included an anteroposterior view and a CT scan that guided the surgical approach by indicating that the fragment of the glenoid cavity was especially dorsal. We carried out a preoperative MRI to eliminate the possibility of a rotator cuff tear being present. The surgical treatment was carried out with the patient in lateral decubitus position and restored normal function to the shoulder.