Concurrent ipsilateral fractures of acetabular posterior wall and femoral shaft associated with posterior hip dislocation: A case report and literature review of a rare injury

Abstract

Introduction

A floating hip injury involving the acetabulum and femur, often complicated by hip dislocation, necessitates a timely and appropriate management strategy to preserve the extremity and patient well-being.

Case presentation

We present a case of a 20-year-old male with concurrent fractures of the acetabular posterior wall, a comminuted femoral shaft, and posterior hip dislocation. Reduction of the dislocated hip posed a challenge due to the femoral shaft fracture. We successfully employed an innovative technique, using pins proximal and distal to the shaft fracture in conjunction with a temporary external fixator, later replaced by an interlocking nail after hip reduction. Subsequently, we addressed the acetabular fracture through a posterior hip approach, enabling the patient to regain full weight-bearing capacity within a few months.

Discussion

In managing concurrent injuries in a floating hip, particularly when a femoral shaft fracture is involved, innovative approaches, such as the one described in this study, are crucial for timely hip reduction. Following hip reduction, a series of surgeries are required to address the multiple lower extremity injuries, prioritizing those with the highest risk of adverse events and neurovascular complications.

Conclusion

Urgent procedures for multiple fractures in orthopedic trauma surgery are pivotal for the best long-term outcomes. Prioritizing these urgent procedures, even through unconventional transient methods when conventional means are unavailable, can prevent long-term complications such as avascular necrosis. Effective and timely management is paramount for optimal patient recovery.

Highlights

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  Floating hip injuries, characterized by combined femoral fracture and acetabulum fracture, are infrequently encountered.

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  Urgent hip dislocation reduction takes precedence over other procedures in the management of such injuries.

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  The presence of a femoral fracture can introduce challenges when attempting to reduce the dislocated hip.