Ipsilateral femoral head and intertrochanteric fractures with posterior subluxation of the hip: A rare case report.

Abstract

Introduction: Hip fractures are common in elderly patients, often accompanied by comorbidities. These fractures can be combined with other injuries, such as a femoral head, neck, or shaft dislocation. The cause of this complex injury is not well-established, but factors like high-energy trauma or falls from a certain height may contribute.

Case presentation: A 55-year-old man presented with an ipsilateral femoral head and left intertrochanteric fracture with posterior hip subluxation after a 3-m fall. This rare and complex injury was diagnosed using X-rays and CT scans. Due to the risk of complications, open reduction and internal fixation (ORIF) using a proximal femoral nail anti-rotation (PFNA) was performed. Early surgical intervention with PFNA provided stable fixation and promoted early mobilization. A 6-month follow-up showed the patient's Lower Extremity Functional Scale (LEFS) was 82.5 %, and Harris Hip Score (HHS) was 85 %, while before surgery, the patient's LEFS was 0 % and HHS was 3,85 %.

Discussion: Intertrochanteric pelvic fractures are serious injuries causing avascular necrosis and traumatic osteoarthritis. They often occur with hip dislocation or acetabular wall fractures. Diagnosis is confirmed through 3D reconstruction. Management involves realigning the dislocated hip, surgical repositioning, and stabilizing the fractured femoral head. Surgical interventions include a sliding compression hip screw, side plate, or intramedullary nail. PFNA is a medical implant for complex fractures.

Conclusion: Open reduction and PFNA can effectively treat ipsilateral femoral head and intertrochanteric fractures with posterior hip subluxation, requiring early intervention, meticulous surgical technique, and appropriate implant selection.