Postoperative Femoral Shaft Malrotation Leading To Recurrent Hip Dislocation In A Patient With Floating Hip Injury: A Case Report.

Floating hip injuries represent high-energy trauma with significant biomechanical instability. When associated with hip dislocation, unrecognized femoral shaft malrotation may alter femoral version and compromise the maintenance of a stable reduction. We present a case of postoperative recurrent hip dislocation following fixation of a floating hip injury, in which femoral shaft malrotation was identified as a key contributing factor. In the initial procedure, the femoral head was reduced prior to femoral shaft fixation and posterior acetabular wall reconstruction. However, due to persistent subluxation at the time of fixation, accurate assessment of femoral rotational alignment was limited, likely resulting in residual malrotation and subsequent instability. We describe a stepwise intraoperative protocol in which femoral head reduction is first achieved and used as the reference for rotational alignment. After removal of distal locking screws, the distal femoral segment is adjusted under fluoroscopic guidance until neutral alignment is restored, followed by definitive fixation. This approach provides a reproducible method for identifying and correcting femoral malrotation in complex floating hip injuries. This case highlights that femoral shaft malrotation is a potential, yet underrecognized, cause of postoperative hip instability. Prioritizing concentric hip reduction before definitive femoral fixation is critical to ensure accurate rotational alignment and prevent recurrent dislocation.