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Abstract: A 60-year-old male patient suffered a sharp abduction and external rotation of the hip joint during a traffic accident, resulting in a dislocation of the hip joint causing a femoral head fracture as well as an acetabular fracture. After timely consultation and treatment with incisional internal fixation surgery, the alignment of the fracture end of the femoral head was restored, and postoperative rehabilitation treatment was provided to heal the patient’s femoral head fracture and restore normal function.
Basic information】Male, 60 years old
Disease Type】Femoral head fracture
Hospital】Harbin First Hospital
Date of consultation】July 2021
Treatment plan】Surgical treatment (incision and internal fixation) + rehabilitation
Treatment Period】7 days of inpatient treatment, 3 months of outpatient follow-up
Results】Femoral head fracture healing, functional recovery
I. Initial consultation
The patient, male, 60 years old, suffered a violent and heavy blow in a serious car accident, which led to the dislocation of the hip joint, and the impact of the femoral head with the acetabulum during the dislocation of the hip joint, resulting in acetabular fracture and femoral head fracture. The hip joint was severely painful locally, the affected limb was abducted and externally rotated and flexed deformed, and it was accompanied by elastic fixation, local swelling in the groin, the dislocated femoral head could be palpated, and passive activities could cause hip muscle spasm and severe pain, and the diagnosis was clearly made by taking X-ray films. As there were multiple injuries, it was impossible to restore the joint function completely through conservative treatment. Therefore, the patient was recommended to adopt internal fixation treatment with incision and rehabilitation to restore the hip joint function as soon as possible.
II. Treatment process
The patient’s general condition met the surgical requirements, and after consideration, he was finally selected for incisional internal fixation. The fracture site was repositioned and fixed with screws, and the acetabular fracture was fixed with titanium plate screws, and the dislocated femoral head was completely reset. After the operation, the patient kept both lower limbs out of the booth to avoid the occurrence of postoperative hip dislocation by crossing the legs. After the pain symptoms were reduced, rehabilitation treatment was carried out under the guidance of the rehabilitation doctor to passively move the hip joint to prevent hip stiffness and resume weight-bearing walking on the lower limbs after the fracture was completely healed.
III. Treatment effect
After the incisional internal fixation surgery, the patient’s hip abduction and external rotation and flexion deformity were completely corrected, while the length of the lower limb was restored, the hip pain symptoms were reduced to disappear, and the patient was able to actively perform mild hip flexion and extension activities. After 7 days of hospitalization, the patient was able to turn in bed on his own, resume normal sleep, sit up in bed and eat on his own, and was discharged from the hospital. After 3 months of postoperative follow-up, the patient recovered well in hip function and the muscles around the hip joint were restored, and no serious hip dysfunction occurred.
IV. Notes
We are glad that the patient’s condition has basically recovered, but we still need to advise the patient to carry out functional exercises of the hip joint according to the principles of postoperative rehabilitation after discharge, so that the hip fracture can heal smoothly and the range of motion of the hip joint can be restored to normal. Since the soft tissues around the hip joint were damaged at the same time, the patient should avoid strenuous exercise until the symptoms disappear. If there is local swelling, appropriate hot compresses can be applied to improve circulation, eliminate inflammation and promote symptom reduction. Ensuring sufficient sleep and balanced nutrition is beneficial to patients’ postoperative recovery. In addition, femoral head fracture may cause traumatic arthritis and femoral head necrosis, which need to be taken seriously and reviewed regularly.
V. Personal insight
The patient had a femoral head fracture caused by a traffic accident, which is a relatively serious hip injury. The flatness of the joint surface is damaged and the rate of degenerative changes of the joint will be significantly accelerated, therefore, the patient should control weight, minimize weight bearing on the hip joint and protect the articular cartilage. In the daily care, intra-articular injection of sodium vitrate should be given regularly to lubricate the joint and nourish the articular cartilage to protect the joint function.