Neglected obturator hip dislocation with associated avascular necrosis of the femoral head in adolescent, a rare case report

Abstract

Introduction and importance

Neglected obturator hip dislocation is rare and possesses a dilemma in management to an orthopedic surgeon however total hip arthroplasty yield good to excellent outcome.

Case presentation

23 years male, with four-month history of painful right hip associated with limping and inability to use the right lower limp, following a motor traffic crush and managed traditionally prior visiting our clinic, he had no any other associated injuries and medical history was uneventfully.

On clinical evaluation, he was alert and oriented, with stable vitals, limping on walking with a stick, his right hip joint was slightly flexed, abducted and externally rotated, with limited hip range of motion and discrepancy of 3 cm.

Pelvis X-ray revealed anterior inferior right hip joint dislocation, shallow acetabula, and features suggestive of avascular necrosis of head and neck.

A diagnosis of neglected right obturator hip dislocation with avascular necrosis of the head and neck was made and advised for Total Hip Arthroplasty; however, patient and family refused the plan due to their financial constraints and traditional believes in spite of proper discussion provided, he was advised on weight bearing as tolerated, using crutches, and follow up visits, however he was lost to follow up.

Discussion

Our case report is unique due to its rarity in occurrence and it was neglected due to traditional believes in their family and poor health seeking behavior. Total hip arthroplasty was considered as a treatment of choice in our case; however, the patient and family refused the option due to financial constraints and traditional believe and trust to bone settlers.

Conclusion

A neglected obturator hip dislocation is very rare and in spite of a dilemma on treatment, total hip arthroplasty is recommended for this case. Community health education should be considered so that hip dislocation being managed as early as possible.