Subchondral fracture of the femoral head after acetabular fracture: a case report

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• 作者：Keiichiro Iida (56)
  Satoshi Hamai (56)
  Takuaki Yamamoto (56)
  Yasuharu Nakashima (56)
  Goro Motomura (56)
  Masanobu Ohishi (56)
  Kazuyuki Karasuyama (56)
  Yukihide Iwamoto (56)
  
  56. Department of Orthopaedic Surgery ; Faculty of Medical Sciences ; Kyushu University ; 3-1-1 Maidashi ; Higashi-ku ; Fukuoka ; 812-8582 ; Japan
  
• 关键词：Acetabular fracture ; Collapse of the femoral head ; Subchondral fracture of the femoral head ; Post ; traumatic osteoarthritis
• 刊名：Journal of Medical Case Reports
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：8
• 期：1
• 全文大小：612 KB
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  17. Tonetti, J, Ruatti, S, Lafontan, V, Loubignac, F, Chiron, P, Sari-Ali, H, Bonnevialle, P (2010) Is femoral head fracture-dislocation management improvable: a retrospective study in 110 cases. Orthop Traumatol Surg Res 96: pp. 623-631 CrossRef
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• 刊物主题：Medicine/Public Health, general; General Practice / Family Medicine; Public Health; Primary Care Medicine;
• 出版者：BioMed Central
• ISSN：1752-1947

文摘

Introduction Preventing post-traumatic osteoarthritis is a challenging problem following acetabular fracture. Progressive osteoarthritis is considered to be caused by an irregular articular surface of the acetabular roof or cartilage injury, but little is known about the pathogenesis of collapse of the femoral head after acetabular fracture. We report a case of post-traumatic osteoarthritis after acetabular fracture in which subchondral fracture of the femoral head contributed to the progressive collapse of the femoral head and osteoarthritis. To the best of our knowledge, there has been no previous report of subchondral fracture of the femoral head after acetabular fracture. Case presentation A 58-year-old Japanese man fell from a ladder. He was diagnosed with a left acetabular fracture, which was managed conservatively. He developed left coxalgia six months after injury and was seen at our institution one year after the onset of pain. The left acetabular fracture had fused, but his left femoral head had collapsed. The images at the time of injury showed a fracture of the acetabular roof, and an approximately 2mm step-off existed in the articular surface. Retrospective evaluation of the plain radiographs and computed tomography images showed that his femoral head had progressively collapsed. Our patient underwent total hip arthroplasty. Histopathologic findings demonstrated that the collapse of his femoral head was caused by a subchondral fracture of his femoral head. Conclusion Our experience with this case indicates that in addition to post-traumatic osteonecrosis, subchondral fracture may need to be considered in cases with progressive collapse of the femoral head after acetabular fracture.