Total Hip Arthroplasty in Severe Fracture-Dislocation of the Hip

Kim, Sang Soo; Rowe, Sung Man; Kim, Kwang Joon

Abstract

Comminuted fracture of the acetabulum in association with dislocation of the hip has aiways been a serious injury because of its protracted convalescent period and the permanent disability. Conventional open reduction, however, has contained much technical difficulties and its end result has usually been disappointing to both the patient and the surgeon. Recent concept is that total hip replacemet can be the primary choice of treatment in the management of such complicated injuries. In contemplating THR in this occasion, however, the acetabular defect secondary to its fracture-dislocation stands out as a primary source af cup loosening atter operation. A special consideration has been given in this respect and in five clinical cases the TMR with our modification was carried out with the following results. 1. In three cases of comminuted central fracture-dislocation of the hip, the gap and deformity of the fractured acetabulum was successfully corrected by inserting two pieces of T-shaped bone graft taken from the removed femoral head. 2. In another two cases of comminuted posterior fracture-dislocation of the hip, the posterior wall defect of the acetabulum was prepared by reduction of the fragments displaced and then temporary fixation with two Steinmann pins during the operative step of cup insertion. The pins could easily be removed after setting of the bone cement. 3. By applying this new modification, the THR surgery was successful and uneventful in all five cases with smooth postoperative courses.