case_images: PMC3426826_01
case_images: Anteroposterior pelvic radiograph (24 year old male) after
  primary THA for secondary osteoarthritis due to Perthes disease
  (Right Hip: cementless CFP stem and TOP acetabular cup; Left
  Hip: Hybrid THA with cemented ENDO Mark III stem +
  cementless TOP acetabular cup, Waldemar Link GmbH, Hamburg,
  Germany).
case_images: TOORTHJ-6-362_F1.jpg
case_images: PMC3426826_01_TOORTHJ-6-362_F1.jpg
case_images: F1
case_images: A 24-year old patient with secondary osteoarthritis of the hips due to Legg-Calve-Perthes disease underwent primary hybrid THA of the left hip seven years before trauma, followed by primary cementless THA of the right hip one year later at our institution (Fig. 1) Six years after the right THA, he was involved in a motorcycle accident, in which he suffered direct trauma to this hip, as well as a complex ankle fracture which was treated in a smaller regional hospital on admission.
case_images: Conventional pelvic radiographs directly after trauma,
  revealing ceramic head fracture.
case_images: TOORTHJ-6-362_F2.jpg
case_images: PMC3426826_01_TOORTHJ-6-362_F2.jpg
case_images: F2
case_images: Although initial anteroposterior radiographs of the pelvis and right hip axial views were performed, no signs of fractures, aseptic loosening or implant damage were diagnosed by the attending trauma surgeons (Fig. 2).
case_images: Anteroposterior pelvic radiograph eight months after the
  initial radiographs, showing a fractured ceramic head.
case_images: TOORTHJ-6-362_F3.jpg
case_images: PMC3426826_01_TOORTHJ-6-362_F3.jpg
case_images: F3
case_images: Further conventional radiographs, in two planes, more than a year after the initial radiographs, revealed a completely destroyed multifragmented ceramic head (Fig. 3).
case_images: Intra-operative image showing countless debris and the
  damaged taper junction of the femoral neck (in situ).
case_images: TOORTHJ-6-362_F4.jpg
case_images: PMC3426826_01_TOORTHJ-6-362_F4.jpg
case_images: F4
case_images: Intraoperatively, extensive damage of the ceramic head and correlating taper junction of the femoral neck was found (Figs. 4, 6, 7).
case_images: Intra-operative image showing debris with ceramic fragments.
case_images: TOORTHJ-6-362_F5.jpg
case_images: PMC3426826_01_TOORTHJ-6-362_F5.jpg
case_images: F5
case_images: Concomitantly, there was severe debris-related metallosis throughout the entire joint (Fig. 5).
case_images: Intra-operative image showing the fragmentation of the
  ceramic head.
case_images: TOORTHJ-6-362_F6.jpg
case_images: PMC3426826_01_TOORTHJ-6-362_F6.jpg
case_images: F6
case_images: Intraoperatively, extensive damage of the ceramic head and correlating taper junction of the femoral neck was found (Figs. 4, 6, 7).
case_images: Image showing the explanted components: a fragmented
  ceramic head, a damaged stem and acetabular cup and liner.
case_images: TOORTHJ-6-362_F7.jpg
case_images: PMC3426826_01_TOORTHJ-6-362_F7.jpg
case_images: F7
case_images: Intraoperatively, extensive damage of the ceramic head and correlating taper junction of the femoral neck was found (Figs. 4, 6, 7).
case_images: Postoperative anteroposterior pelvic radiograph.
case_images: TOORTHJ-6-362_F8.jpg
case_images: PMC3426826_01_TOORTHJ-6-362_F8.jpg
case_images: F8
case_images: The postoperative course was uneventful, with radiographs revealing a correct position and articulation of the cementless implant (Fig. 8).