これは痛そうだ。よりによって・・：NEJMのイメージ

これは痛そうだ。よりによって・・なんでまたこうなるの。

バイク事故の33歳男子。ドイツからの症例報告。救急室の触診で堅く腫れあがった陰嚢です。左大腿骨骨頭部の骨折で骨頭の一部が左陰嚢に落ち込んでいる（黄色の↓）Ｃでみるように陰嚢をオープンにして、取り出した骨頭を再接合している。術後14ヶ月で杖無し歩行可能だそうだ。腐骨化していないのが素晴らしい。

しかし事実は小説よりも奇なりである。まったく・・・

Images in Clinical Medicine

Femoral-Head Dislocation to the Scrotum

Andreas Schicho, M.D., and Christoph Riepl, M.D.

N Engl J Med 2015; 372:863   February 26, 2015


Andreas Schicho, M.D.
Christoph Riepl, M.D.
Ulm University, Ulm, Germany  

A 33-year-old man was admitted to the emergency department after a motorcycle accident. Clinical examination of the intubated patient showed a hard, swollen, bluish scrotum and an externally rotated and slightly shortened left leg. Computed tomography (CT) of the pelvis revealed dislocation of the left hip and a three-part trochanteric fracture of the proximal left femur (Panel A, white arrow), with displacement of the femoral head and neck fragment into the scrotum (Panels A and B, yellow arrow). There were also fractures of the left anterior pelvic ring and acetabulum (Panels A and B, blue arrow) and open fractures of the right forearm and hand. The femoral head and neck fragment was retrieved by means of a direct scrotal incision (Panel C), and the fractures were treated with open reduction and internal fixation (Panel D). The patient had no urologic sequelae. After 8 weeks of limited weight-bearing, the patient was able to walk with a cane. There was no evidence of avascular necrosis of the femoral head on the 3-month follow-up CT scan. At 14 months of follow-up, a CT scan showed vital bone structure and still no avascular necrosis of the femoral head, and the patient was able to walk freely without a cane.