Posterior Hip Dislocation with Ipsilateral Subtrochanteric Femur Fracture: A Rare Case Report.

Abstract

Introduction: Posterior dislocation of the hip associated with an ipsilateral subtrochanteric femur fracture is a rare and technically challenging injury pattern, most commonly seen after high-energy trauma such as road traffic accidents. The associated proximal femoral fracture disrupts the normal femoral lever arm, making closed reduction difficult or impossible and often necessitating open reduction. Delay in diagnosis or treatment may result in complications such as avascular necrosis of the femoral head, post-traumatic arthritis, sciatic nerve injury, and poor functional outcomes.

Case report: We report the case of a 35-year-old male who sustained posterior hip dislocation with an ipsilateral subtrochanteric femur fracture following a road traffic accident. The patient presented with pain, deformity, and inability to bear weight on the affected limb. As he was hemodynamically unstable at presentation, definitive surgery was delayed until adequate resuscitation and stabilization were achieved. Surgery was performed within 72 h and included open reduction of the hip through a posterior approach using a Steinmann pin as a joystick for reduction, followed by fixation of the subtrochanteric fracture using a proximal femoral nail (PFN). At 15 days follow-up, the wound had healed well, implant position was satisfactory, and no early post-operative complications were noted.

Conclusion: Posterior hip dislocation with ipsilateral subtrochanteric femur fracture is an uncommon injury that requires early diagnosis, careful surgical planning, and stable fixation. Open reduction is often necessary because closed reduction may not be feasible due to loss of the proximal femoral lever arm. Joystick-assisted reduction with a Steinmann pin and fixation with PFN can provide satisfactory early outcomes. Long-term follow-up remains essential to monitor for complications such as avascular necrosis and post-traumatic arthritis.