Journal of Orthopaedic Reports (Sep 2024)
Urethro-acetabular Fistula leading to bony ankylosis of hip: Case report
Abstract
Introduction: Fistulas between urethra and hip joint are rare. Only six cases of urethra-acetabular fistula have so far been reported in literature. Case reported herein may be just the seventh ever reported case of Fistula between urethra and hip joint. Case report: Urethral Fistula was positively diagnosed by a cysto-urethrographic study. Communication of Urethral fistula with splinter of bomb blast, lodged on quadrilateral plate on medial wall of acetabulum was also established in cysto-urethrographic study itsel. Hip involvement was insidious in onset without symptoms of overt septic hip, neither at time of injury nor in follow up period except for recurring relapsing discharging sinus. Leakage of dye of sinogram around femoral head established track from splinter to hip joint. Decreased hip joint space, well recognisable even in cysto-urethrographic study progressed to bony ankylosis slowly over 7 years. Discussion: Scientific rationale of absence of overt clinical symptoms of septic arthritis, its insidious onset, slow progression is discussed. Rationale of development of Discharging sinus posterior on buttock despite wound of entry of splinter being in perineum is discussed. Conclusion: Presented here is first ever case of urethroacetabular fistula resulting from splinter of a bomb blast and only second from a penetrating injury, second with no associated fractures in pubic rami or acetabulum. This is also first ever report of long-term outcome of septic arthritis of a urethro-acetabular fistula. The learning point is that a urethra-acetabular fistula may follow a benign course and painless bony ankylosis occurs as the final sequelae if no intervention is done.
