Restoring a near anatomical hip joint in an 18 year old neglected hip fracture dislocation – A rare case report

Abstract

Long standing neglected traumatic hip fracture dislocation is a rare clinical condition. Obliteration of the native acetabulum, soft tissue contractures, loss of femoral head congruity and associated hip fractures make this condition challenging to treat. We discuss a case of a middle-aged male presenting to us with pain, shortening and inability to bear weight on left lower limb for last 15 years. Clinical examination revealed an adduction deformity over the left hip, a globular swelling in the left gluteal region and a fixed equinus deformity over left ankle. Movements at the left hip hinted at restricted internal rotation and flexion. Pelvis radiographs revealed a neglected posterior hip dislocation with ipsilateral femur neck non union. Patient underwent initial upper tibial traction for 8 weeks followed by a hybrid Total Hip Arthroplasty. Postoperatively intensive physiotherapy was continued and with correction of the ankle equinus patient was able to ambulate. On five years follow-up, the patient was mobilizing independently, pain-free with a mild short limb gait and some residual foot drop.Treatment of neglected hip fracture dislocation can be challenging. Associated economic restraints may hinder clinicians from higher imaging and make the treatment even difficult. However, an anatomical reconstruction of hip by a total hip arthroplasty has yielded good functional outcomes in long standing neglected dislocations.’