Femoral-Head Dislocation to the Scrotum
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.
