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  • Kaoa Nov 2023

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    manan shroff
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    A 25-year-old male patient presented with a 1.5 year old fracture of the head of the femur with a posterior wall fracture and posterior hip dislocation that was initially managed without surgery. This resulted in approximately 6cm of shortening. The patient underwent a two-stage procedure, first with adductor tenotomy and skeletal traction for 6 weeks to lengthen the leg, followed by a total hip replacement. The surgery was difficult due to extensive fibrosis and altered soft tissue anatomy from the longstanding injury and non-operative treatment. After extensive releases during the total hip replacement, only 2cm of lengthening was achieved, leaving the patient with 2cm of residual shortening, but with a stable hip joint.

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    A 25-year-old male patient presented with a 1.5 year old fracture of the head of the femur with a posterior wall fracture and posterior hip dislocation that was initially managed without surgery. This resulted in approximately 6cm of shortening. The patient underwent a two-stage procedure, first with adductor tenotomy and skeletal traction for 6 weeks to lengthen the leg, followed by a total hip replacement. The surgery was difficult due to extensive fibrosis and altered soft tissue anatomy from the longstanding injury and non-operative treatment. After extensive releases during the total hip replacement, only 2cm of lengthening was achieved, leaving the patient with 2cm of residual shortening, but with a stable hip joint.

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    1 views10 pages

    Kaoa Nov 2023

    Uploaded by

    manan shroff
    A 25-year-old male patient presented with a 1.5 year old fracture of the head of the femur with a posterior wall fracture and posterior hip dislocation that was initially managed without surgery. This resulted in approximately 6cm of shortening. The patient underwent a two-stage procedure, first with adductor tenotomy and skeletal traction for 6 weeks to lengthen the leg, followed by a total hip replacement. The surgery was difficult due to extensive fibrosis and altered soft tissue anatomy from the longstanding injury and non-operative treatment. After extensive releases during the total hip replacement, only 2cm of lengthening was achieved, leaving the patient with 2cm of residual shortening, but with a stable hip joint.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    Download as pptx, pdf, or txt
    of 10

    Case presentation

    -Dr. Hemant Soni


    Senior Resident,
    Dept of Orthopaedics, PSMC
    • A 25 year old male patient presented
    with1.5 year old head of femur
    fracture with posterior wall fracture
    (pipkin type 4) with posterior hip
    dislocation on left side.
    • Managed elsewhere primarily and
    patient denied for any operative
    intervention then.
    • Patient had ~ 6cm shortening
    Any ideas ?
    1st stage

    • Adductor tenotomy done and


    skeletal traction given for 6 weeks.
    • 6 weeks continuous traction
    • Gradually increased to 9kg
    Total hip replacement

    • KL approach
    • Extensive release done:
    • TFL release
    • Gluteus maximums released
    • Iliopsoas released
    • Indirect head of recuts released
    • Anterior capsule released
    Difficulties in THR
    • Extensive fibrosis around acetabulum- reaming difficult and more bleeding encountered
    • Reaming done till maximum coverage achieved in acetabular cup
    • Sciatic nerve anatomy altered - careful dissection and exploration done
    • After all this, only 2cm of lengthening achieved
    • The aim was to achieve a stable joint.

    • Patient still has 2cm shortening but is happy


    Thank you !

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