case_images: PMC6588131_01
case_images: Plain X-ray: Obturator hip dislocation with medial wall fracture and femoral head impaction.
case_images: JOCR-9-65-g001.jpg
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case_images: F1
case_images: He sustained an obturator dislocation of the right hip associated with a severe femoral head impaction fracture in the weight-bearing zone and a medial wall fracture of the acetabulum (Fig. 1, 2, 3).
case_images: Transversal computed tomography scan showing the dislocation of the femoral head into the obturator foramen with associated severe femoral head damage and medial wall fracture.
case_images: JOCR-9-65-g002.jpg
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case_images: F2
case_images: He sustained an obturator dislocation of the right hip associated with a severe femoral head impaction fracture in the weight-bearing zone and a medial wall fracture of the acetabulum (Fig. 1, 2, 3).
case_images: Coronal computed tomography scan after closed reduction showing the extent of the femoral head impaction, some small intra-articular fragments, and the multifragmentary medial wall fracture
case_images: JOCR-9-65-g003.jpg
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case_images: F3
case_images: He sustained an obturator dislocation of the right hip associated with a severe femoral head impaction fracture in the weight-bearing zone and a medial wall fracture of the acetabulum (Fig. 1, 2, 3).
case_images: Intraoperative view of the femoral head impaction fracture after surgical hip dislocation.
case_images: JOCR-9-65-g004.jpg
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case_images: F4
case_images: The local bone situation was assessed afterward: A large (2 cm x 2 cm x 1 cm) osseous head defect was present at the superior junction from head to neck, extending from anterior to posterior (Fig. 4) and the capital head ligament was still intact.
case_images: Bleeding of the femoral head through competentanastomoses from the inferior retinacular vessels.
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case_images: F5
case_images: Despite the complete destruction of the superior retinacular vessels due to the severe impaction at the head-neck junction active bleeding through intraosseous anastomoses from the inferior retinacular vessels was present after a hole of 1.5 mm was drilled in the femoral head (Fig. 5).
case_images: Pre-operative planning showing the extent of valgization needed to achieve a
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case_images: F6
case_images: Then, according to the pre-operative plan (Fig. 6) a 25  closing wedge intertrochanteric osteotomy was performed aiming to turn the head impaction out of the weight-bearing zone.
case_images: Reshaping of the head and reinforcement of the neck with a bone block taken at the osteotomy sitecongruous hip joint.
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case_images: F7
case_images: The large head defect was filled with the reshaped bone block removed at the osteotomy site and stabilized with two 2 mm cortical screws (Fig. 7).
case_images: Post-operative radiographs.
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case_images: F8
case_images: After head reduction, the intertrochanteric osteotomy was stabilized with a 120  blade plate (Depuy Synthes; 4528 Zuchwil Switzerland) and the trochanteric osteotomy with additional 4.5 mm lag screws (Fig. 8).
case_images: Radiographs at 5 years
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case_images: F9
case_images: Radiographs demonstrated union of all osteotomies; osseous integration and remodeling of the bone graft as well as correct congruity and containment of the hip joint, without signs of osteoarthritis (Fig. 9, 10, 11).
case_images: Computed tomography in transversal plane at 5 years showing remodeling of the head.
case_images: JOCR-9-65-g010.jpg
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case_images: F10
case_images: Radiographs demonstrated union of all osteotomies; osseous integration and remodeling of the bone graft as well as correct congruity and containment of the hip joint, without signs of osteoarthritis (Fig. 9, 10, 11).
case_images: Computed tomography in coronal plane at 5 years.
case_images: JOCR-9-65-g011.jpg
case_images: PMC6588131_01_JOCR-9-65-g011.jpg
case_images: F11
case_images: Radiographs demonstrated union of all osteotomies; osseous integration and remodeling of the bone graft as well as correct congruity and containment of the hip joint, without signs of osteoarthritis (Fig. 9, 10, 11).