Femoroacetabular impingement after the femoral neck fracture healed in a nonanatomical position
Abstract
Abstract
Introduction. Femoroacetabular impingement is the result of the pathological conditions in the osseous acetabulum and/or the proximal femur. One of its causes is a non-anatomically healed femoral neck fracture. Case report. A male, aged 51, with a subcapital left femoral neck fracture was treated conservatively. The fracture healed 9 months later and although the patient was walking on crutches he suffered from pain in the left groin. The X-ray images showed the valgus and the retroposition of the left femoral head. The patient was operated on and intraoperatively the thickness and a bone prominence in the anterosuperior femoral neck area in the line of the previous fracture were found, which was pressing and spreading beneath the acetabular labrum, thus squeezing the acetabular cartilage. The labrum lesion which was found was the result of the mechanical pressure of the existing femoral neck deformity during the hip movements. Irretrievably damaged part of the labrum was resected and the anterosuperior femoral head-neck osteochondroplasty was done. One year after the surgery, the patient had no pain, he walked without limping, the impingement test was negative, the radiological parameters were adjusted and there were no signs of the avascular necrosis of the femoral head. Conclusion. The femoral neck fracture should be treated adequately with the full anatomical position and the proper internal fixation. If the deformity occurs as the result of a treatment, it should be removed as soon as possible to prevent the osteoarthritis of the hip.
References
REFERENCES
Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003; (417): 112–20.
Wagner S, Hofstetter W, Chiquet M, Mainil-Varlet P, Stauffer E, Ganz R, et al. Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthr Cartil 2003; 11(7): 508–18.
Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res 2004; (418): 61–6.
Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: Femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 2005; 87(7): 1012–8.
Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol 1965; 38(455): 810–24.
Solomon L. Patterns of osteoarthritis of the hip. J Bone Joint Surg Br 1976; 58(2): 176–83.
Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 1999; 81(12): 1747–70.
Mladenović D, Andjelković Z, Vukasinović Z, Mitković M, Milenković S, Micić I, et al. Early clinical results of surgical treatment of patients with femoroacetabular impingement. Srp Arh Celok Lek 2014; 142(5–6): 325–9.
Mladenović M, Andjelković Z, Micić I, Mladenović D, Stojiljković P, Milenković T. Surgical dislocation of the hip in patients with femoroacetabular impingement: Surgical techniques and our experience. Vojnosanit Pregl 2015; 72(11): 1004–9.
Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res 2004; (429): 178–81.
Mladenović M, Micić I, Andjelković Z, Mladenović D, Stojiljković P. Unusual case of mixed form of femoroacetabular impingement combined with nonspecific synovitis of the hip joint in a young adult-- A case report. Vojnosanit Pregl 2015; 72(12): 1132–5.
Stulberg SD, Cordell LD, Harris WH, Ramsey PL, MacEwen GD. Unrecognized childhood hip disease: A major cause of idiopathic osteoarthritis of the hip. In: Amstutz HC, editor. The Hip: Proceedings of the Third Open Scientific Meeting of the Hip Society. St Louis, MO: CV Mosby; 1975. p. 212–28.
Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res 2004; (418): 54–60.
Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR. Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Joint Surg Am 1997; 79(10): 1489–97.
Leunig M, Casillas MM, Hamlet M, Hersche O, Nötzli H, Slongo T, et al. Slipped capital femoral epiphysis: Early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand 2000; 71(4): 370–5.
Snow SW, Keret D, Scarangella S, Bowen JR. Anterior impingement of the femoral head: a late phenomenon of Legg-Calvé-Perthes' disease. J Pediatr Orthop 1993; 13(3): 286–9.
Vukašinović Z, Spasovski D, Živković Z. Femoroacetabular impingement related to Legg-Calvé-Perthes disease. Srp Arh Celok Lek 2011; 139(11–12): 834–7. (Serbian)
Kloen P, Leunig M, Ganz R. Early lesions of the labrum and acetabular cartilage in osteonecrosis of the femoral head. J Bone Joint Surg Br 2002; 84(1): 66–9.
Eijer H, Myers SR, Ganz R. Anterior femoroacetabular impingementafter femoral neck fractures. J Orthop Trauma 2001; 15(7): 475–81.
Ganz R, Bamert P, Hausner P, Isler B, Vrevc F. Cervico-acetabular impingement after femoral neck fracture. Unfallchirurg 1991; 94(4): 172–5. (German)
McCarthy JC. The diagnosis and treatment of labral and chondral injuries. Instr Course Lect 2004; 53: 573–7.
Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH Jr. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res 2001; (382): 232–40.
Kim YT, Azuma H. The nerve endings of the acetabular labrum. Clin Orthop Relat Res 1995; (320): 176–81.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15(12): 1833–40.
Andjelković Z, Mladenović D, Vukasinović Z, Arsić S, Mitković M, Micić I, et al. Contribution to the method for determining femoral neck axis. Srp Arh Celok Lek 2014; 142(3–4): 178–83.
Tonnis D. Normal values of the hip joint for the evaluation of X rays in children and adults. Clin Orthop Rel Res 1976; (119): 39–47.
Wiberg G. Studies on dysplastic acetabular and congenital subluxation of the hip joint. Acta Orthop Scand 1939; 83(Suppl 58): 7–38.
Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002; 84(4): 556–60.
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(8): 1119–24.
Gautier E, Ganz K, Krügel N, Gill T, Ganz R. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg Br 2000; 82(5): 679–83.
Mardones RM, Gonzalez C, Chen Q, Zobitz M, Kaufman KR, Trousdale RT. Surgical treatment of femoroacetabular impingement: Evaluation of the effect of the size of the resection. J Bone Joint Surg Am 2005; 87(2): 273–9.
Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J, et al. Hip contact forces and gait patterns from routine activities. J Biomech 2001; 34(7): 859–71.
Malik A, Maheshwari A, Dorr LD. Impingement with total hip replacement. J Bone Joint Surg Am 2007; 89(8): 1832–42.
Leunig M, Werlen S, Ungersböck A, Ito K, Ganz R. Evaluation of the acetabular labrum by MR arthrography. J Bone Joint Surg Br 1997; 79(2): 230–4.