Initial Misdiagnosis of a Traumatic Ceramic Femoral Head Fracture

Abstract

A destructive ceramic head fracture was diagnosed 1 year after a serious motorcycle accident in a patient who had undergone primary THA 7 years earlier. Introduction In the 1970s, Boutin implemented ceramic in modern total hip arthroplasty (THA). Although initial fracture rates of 13.4 % for ceramic heads were described before the 1990s, the inferior rate of wear and friction when compared with metallic heads and the optimized tribology wre promising in THA [1-3]. Gradual improvements in processing of the material led to a significant reduction of the fracture rate to below 0.1 % [3]. Thus, alumina ceramic heads have currently become the standard material in THA with ceramic bearing surfaces. Nevertheless, multiple case reports have been published describing ceramic head fractures [4-11]. The causes of fractures are diverse and vary from traumatic events [5,9,12,13] to impingement between the neck and the liner rim [7]. Spontaneous fractures without any history of trauma have also been described [4,6,8,10,11]. However, only two reports describing delayed fractures of ceramic heads were found [12,13]. In this report, we present a 24-year old patient who underwent primary THA at our institution and was a victim of high-energy trauma 7 years later. Initial radiographs were misinterpreted in a non-designated total joint clinic at the time of primary admission (after the accident). A destructive ceramic head fracture was diagnosed more than 1 year after initial trauma at our institution, with major destruction of the ceramic head and the remaining THA. This was followed by an extensive revision. Based on this experience, the general question of adequate radiographic diagnosis after trauma to a THA, especially one with partial or full ceramic bearing surfaces, will be further discussed in this report.