- Discussion: - central frx/dislocation is crippling injury with a poor prognosis; - extensive degree of concomitant articular injury occurs; - 22% incidence of
sciatic nerve injury; - distal and occassionally, lateral traction of proximal femur may be necessary to effect and maintain reduction of the femoral head; - total hip arthroplasty may be the treatment of choice;
- Types of Fractures: - undisplaced fractures (either single line or stellate types)
- inner wall frx: - femoral head concentrically reduced beneath dome on initial films; - head not reduced under acetabular dome but centrally dislocated;
- superior dome frx: - gross outline of acetabular dome intact & congruous w/ fem head - gross outline of acetabular dome not intact nor congruous w/ femoral head;
- bursting frx (all elements of the acetabulum involved) - congruity remains between femoral head & acetabular dome - there is incongruity between femoral head & acetabular dome
- Treatment: - once the head/acetabular relationship is restored, pt is maintained in longitudinal traction for 10-12 weeks; - lateral traction thru a trochanteric pin is used to reduce the joint and if necessary can be maintained for 8-10 weeks if necessary;
- Complications: - Infection in the Retroperitoneal Space: - central frx dislocation of femur is frequently accompanied by retroperitoneal bleeding; - if pin tract infection occurs around fixation device in greater trochanter, infection could spread to involve retroperitoneal space; - Residual Joint Incongruity:
