Irreducible posterior fracture-dislocation of the hip associated with an ipsilateral femoral shaft fracture: A case report and review of the literature.

INTRODUCTION: Ipsilateral fractures of the shaft of the femur combined with hip dislocations are extremely rare injuries, presenting a difficult diagnostic and therapeutic challenge. Diagnosis of hip dislocation is often delayed, due to the focus on femoral fracture.

CASE PRESENTATION: This article presents a case never described before of a 19-year-old patient who sustained this unusual combination of injuries as a result of a road traffic accident. The patient had an irreducible posterior hip fracture-dislocation associated with an ipsilateral femoral shaft fracture. Closed reduction attempts were unsuccessful, leading to the requirement for open reduction, via the posterolateral approach of the hip, which revealed that the femoral head buttonholed through the capsule. We proceeded to the reduction of the left hip with the osteosynthesis of the posterior wall acetabular fragment, and then the femur shaft fracture was fixed using an intramedullary nail. After 19 months postoperative follow-up, the patient had full range motion of the affected hip without any pain.

DISCUSSION: Closed reduction techniques, including various external devices, have been explored, with some success in specific cases. However, open reduction remains a crucial option, especially in irreducible dislocations. Complications, such as avascular necrosis of the femoral head and neurovascular injury, illustrate the importance of accurate diagnosis and appropriate treatment.

CONCLUSIONS: In conclusion, ipsilateral femoral shaft fractures combined with hip dislocations represent a rare and challenging orthopedic emergency. Timely diagnosis, careful assessment, and consideration of both closed and open reduction techniques are essential in managing these complex injuries.