Central hip dislocation and complex acetabulum fracture

Abstract

Introduction: Central hip dislocation combined with a complex acetabular fracture is a high-energy trauma emergency associated with significant morbidity. Accurate surgical diagnosis and treatment are essential to prevent severe complications, such as avascular necrosis of the femoral head and post-traumatic osteoarthritis. Objective: To describe the clinical features, two-stage surgical management, and to evaluate the functional outcomes and postoperative complications in the medium term in a patient with this injury.

Case report: We present a 68-year-old man who sustained direct trauma to the right hip after a high-speed bicycle accident. The patient was transferred 17 hours post-injury with a central dislocation and loss of function. Following initial stabilization with skeletal traction, a two-stage surgical procedure was planned: 1) open reduction and osteosynthesis using the Kocher-Langenbeck posterolateral approach, with reconstruction plate, interfragmentary screws, bone graft, and titanium mesh in the acetabular roof; 2) conversion to total hip arthroplasty (THA) three months later.

Results: The patient developed a femoral deep vein thrombosis (DVT) in the immediate postoperative period, which necessitated the placement of a vena cava filter and anticoagulation therapy. At six months follow-up, the functional outcome, assessed using the modified Merle d'Aubigné scale, was excellent (18 points).

Conclusion: Central hip dislocation with a complex acetabular fracture requires prompt intervention and personalized planning. In complex cases, a sequential approach involving reduction, stable fixation, and subsequent conversion to THA can be an effective strategy to achieve a good functional outcome in the médium term.