Obturator dislocation of hip with femoral neck fracture

A 68-year-old woman was brought to the emergency department after being struck by a car from behind while walking. She complained of left hip pain and underwent pelvic radiography, computed tomography (CT), and three-dimensional CT, which revealed a fracture of the left femoral neck and insertion of the left femoral head into the left obturator foramen (Figure 1). Indirect traction was performed in the emergency room, and the femoral head, firmly seated in the obturator foramen, was removed later by an anterolateral approach to the hip, followed by total hip arthroplasty (THA). Obturator dislocation of the hip joint is rarely associated with a femoral neck fracture, and there are only nine reports of such cases in English literature.¹ Anterior dislocation occurs when the hip is forced into abduction and external rotation, causing impingement of the femoral neck or greater trochanter and acetabulum, and the femoral head is pulled forward from the acetabulum.² Anterior hip joint dislocation can be classified into obturator dislocation and suprapubic dislocation. However, obturator dislocation is reported to occur when the hip joint is externally rotated in the flexed position, and further forced external rotation can result in a femoral neck fracture.³ In some cases, osteosynthesis has been chosen for surgery in younger patients, but THA is recommended for elderly patients to avoid complications such as avascular necrosis and nonunion.¹

The authors declare no conflicts of interest.

Approval of the research protocol: None.

Informed consent: Informed consent was obtained from the patient.

Registry and the registration no. of the study/trial: None.

Animal studies: None.