Shree Vishudanand Hospital, India
Rajesh Kushwaha is a Consultant orthopaedic surgeon and Head of trauma unit at Shree Vishudanand hospital and research institute (Kolkata). He is also the Head of cerebral palsy unit at Mahavir Seva Sadan. Freelancing Consultant orthopaedic surgeon at Bellevue clinic, Medicare nursing home and Marwari relief society hospital.
60-year male patient presented with fracture neck femur right side with acetabular floor fracture. Femoral head migrated through the acetabular floor defect into the pelvis and lying free floating in the pelvic cavity. Patient was operated once at periphery with exposure of hip by posterior approach and failure to retrieve head of femur from the pelvic cavity. CT scan and3D reconstruction images of hip showed acetabular floor defect and fracture of acetabulum anterior column and wall with head of femur lying inside the true pelvis near superior pubic rami brim. Single stage surgery was planned. Head of femur was extracted from true pelvis by right anterior illioinguinal approach. Acetabular floor and wall reconstruction done with recon plate fixation.
Cemented THR done in lateral decubitus position through old posterior approach. Mesh wire net was used in floor of reconstructed acetabulum to prevent cement leak into pelvic cavity. Gentle range of movement’s hip joint started from the next post-operative day and was mobilised with walker. Full weight bearing mobilisation started after suture removal.
Conclusion: acetabular fractures are complex fractures and difficult to treat due to its complex anatomy and proximity to vital structures. Fracture of acetabulum associated with dislocation of hip, protrusio, central dislocation has been reported in literature. However acetabular fracture with neck femur fracture and migration of free floating femoral head into the true pelvis is very rare and not reported. Single stage fracture fixation and Total hip replacement is good option for pain free early mobilisation. However, one should be familiar with different approaches to remove the femoral head from the pelvic cavity.