Yonsei Med J.  2016 Nov;57(6):1527-1530. 10.3349/ymj.2016.57.6.1527.

Osteochondral Autograft from the Ipsilateral Femoral Head by Surgical Dislocation for Treatment of Femoral Head Fracture Dislocation: A Case Report

• Won Y
• Lee GS
• Kim SB
• Kim SJ
• Yang KH

• KMID: 2427176
• DOI: http://doi.org/10.3349/ymj.2016.57.6.1527

Abstract

As anatomical reduction of the articular surface of femoral head fractures and restoration of damaged cartilage are essential for good long-term results, many treatment options have been suggested, including fixation of the fracture using various surgical exposures and implants, as well as arthroscopic irrigation and debridement, bone marrow stimulating techniques, osteochondral allograft, autograft, and autogenous chondrocyte implantation. We report a case of osteochondral autograft harvested from its own femoral articular surface through surgical hip dislocation. The osteochondral graft was harvested from the inferior non-weight-bearing articular surface and grafted to the osteochondral defect. One year later, the clinical and radiological results were good, without the collapse of the femoral head or arthritic change. This procedure introduced in our case is considered convenient and able to lessen surgical time without morbidity of the donor site associated with the harvest.

Keyword

Femoral head; hip dislocation; autograft transplant; fractures cartilage

MeSH Terms

Adult
Autografts
Bone Transplantation/*methods
Chondrocytes
Female
Femoral Fractures/diagnostic imaging/*surgery
Femur Head/diagnostic imaging/*injuries/surgery
Fracture Dislocation/diagnostic imaging/*surgery
*Hip Dislocation
Humans
Male
Osteotomy/*methods
Radiography
Salvage Therapy/*methods
Transplantation, Autologous
Treatment Outcome

Figure

• 

  Fig. 1 (A) Plain radiograph showing femoral head fracture. (B and C) CT scan showing Pipkin type II femoral head fracture. (D) CT sagittal scan show femoral defect of weight bearing portion.

• 

  Fig. 2 (A) 2.5×1 cm femoral head defect is visible after fixation of the main fragment. (B) OATS was performed with a bone plug harvested from the inferior non-weight bearing portion of the affected femoral head. (C) OATS was performed using a headless 3.5 mm compression screw. OATS, osteochondral autologous graft transplantation surgery.

• 

  Fig. 3 (A and B) One year after the operation, plain radiograph and CT scan shows good fixation and articulation. (C) Arthroscopic findings one year after the operation show mild fraying and softening, but the overall surface was regenerated with fibrocartilage tissue.

Reference

1. Pipkin G. Treatment of grade IV fracture-dislocation of the hip. J Bone Joint Surg Am. 1957; 39-A:1027–1042 passim.

2. Davis JB. Simultaneous femoral head fracture and traumatic hip dislocation. Am J Surg. 1950; 80:893–895.

3. Butler JE. Pipkin Type-II fractures of the femoral head. J Bone Joint Surg Am. 1981; 63:1292–1296.

4. Henle P, Kloen P, Siebenrock KA. Femoral head injuries: which treatment strategy can be recommended? Injury. 2007; 38:478–488.

5. Hougaard K, Thomsen PB. Traumatic posterior fracture-dislocation of the hip with fracture of the femoral head or neck, or both. J Bone Joint Surg Am. 1988; 70:233–239.

6. Mowery C, Gershuni DH. Fracture dislocation of the femoral head treated by open reduction and internal fixation. J Trauma. 1986; 26:1041–1044.

7. Kish G, Módis L, Hangody L. Osteochondral mosaicplasty for the treatment of focal chondral and osteochondral lesions of the knee and talus in the athlete. Rationale, indications, techniques, and results. Clin Sports Med. 1999; 18:45–66. vi

8. Ganz R, Gill TJ, Gautier E, Ganz K, Krügel N, Berlemann U. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br. 2001; 83:1119–1124.

9. Horas U, Pelinkovic D, Herr G, Aigner T, Schnettler R. Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. A prospective, comparative trial. J Bone Joint Surg Am. 2003; 85-A:185–192.

10. Smith GD, Richardson JB, Brittberg M, Erggelet C, Verdonk R, Knutsen G, et al. Autologous chondrocyte implantation and osteochondral cylinder transplantation in cartilage repair of the knee joint. J Bone Joint Surg Am. 2003; 85-A:2487–2488.

11. Nam D, Shindle MK, Buly RL, Kelly BT, Lorich DG. Traumatic osteochondral injury of the femoral head treated by mosaicplasty: a report of two cases. HSS J. 2010; 6:228–234.

12. Hart R, Janecek M, Visna P, Bucek P, Kocis J. Mosaicplasty for the treatment of femoral head defect after incorrect resorbable screw insertion. Arthroscopy. 2003; 19:E1–E5.

13. Sugioka Y. Transtrochanteric anterior rotational osteotomy of the femoral head in the treatment of osteonecrosis affecting the hip: a new osteotomy operation. Clin Orthop Relat Res. 1978; 191–201.

14. Gagala J, Tarczyńska M, Gawęda K. Clinical and radiological outcomes of treatment of avascular necrosis of the femoral head using autologous osteochondral transfer (mosaicplasty): preliminary report. Int Orthop. 2013; 37:1239–1244.

15. Hangody L, Kish G, Kárpáti Z, Udvarhelyi I, Szigeti I, Bély M. Mosaicplasty for the treatment of articular cartilage defects: application in clinical practice. Orthopedics. 1998; 21:751–756.