Bone Grafting and Reverse Hybrid Fixation Technique for Treating Neglected Posterior Dislocation of the Hip with Acetabulum Fracture in a Young Adult: A Case Report
I Putu Surya Fajari Widhiarma *
Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
I Wayan Suryanto Dusak
Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Posterior hip dislocations with acetabular fractures result from high-energy trauma, necessitating urgent medical attention due to their severity and potential complications. The posterior dislocation of the hip occurs when the femoral head is forced out of the acetabulum, typically accompanied by fractures to the acetabular wall. The complexity of these injuries presents a significant challenge in terms of diagnosis, treatment, and long-term management, with potential complications that can affect the patient’s quality of life. Neglected cases pose additional challenges, often requiring total hip replacement (THR) to restore function and mitigate complications. Development of avascular necrosis has been reported to range from 3% to 58% following traumatic hip dislocations.
Aim: This case report aims to highlight the complexities and treatment considerations for neglected posterior hip dislocations with acetabular fractures, particularly of the Judet-Letournel basic type posterior wall.
Case Presentation: A 35-year-old male presented with severe right hip pain for two months after a motorcycle accident and functional impairment with a tibia fracture, delaying diagnosis of neglected right hip dislocation with a posterior wall acetabular fracture. Limb length discrepancy (LLD) was 3 cm, and Harris Hip Score (HHS) was 68, which is a poor result. THR was followed by placing a bone graft from the femoral head and fix it with three screws, then perform reverse reaming on the bone graft. The patient does not experience pain after 6 months post-operation. The HHS at six months post-operation was 89, which is a good result.
Discussion: Neglected cases were challenges, and a complex treatment approach was required. The choice of THR with reverse hybrid fixation technique was guided by the patient's age and bone quality to restore joint function, alleviate pain, and enhance quality of life. This approach aimed to balance the benefits of both fixation methods, ensuring stability and promoting long-term implant survival. The use of reverse hybrid fixation in younger patients highlights its lower revision rates compared to other fixation methods. There was an improvement in LLD and the HHS from the preoperative compared to six months post-operative.
Conclusion: This case highlights the management complexities of neglected posterior hip dislocation with acetabular fracture. Timely intervention and appropriate surgical strategies, including THR with specific implant choices for optimal patient outcomes and long-term joint health. Also, this case underscores the critical role of timely intervention and tailored surgical strategies in achieving favourable outcomes, emphasising the importance of early recognition and comprehensive management in optimising patient recovery and long-term joint health.
Keywords: Hip dislocation, acetabular fracture, reverse hybrid, posterior hip, total hip replacement