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.