Ipsilateral Acetabular Fracture with Displaced Femoral Head and Femoral Shaft Fracture: A Complex Floating Hip Injury

Abstract

Floating hip injuries involving the acetabulum, femoral head, and the femoral shaft are a very rare presentation. A complex floating hip injury comprising of an ipsilateral acetabular fracture associated with a displaced femoral head fracture and a femoral shaft fracture following a high-velocity road traffic accident presented to us where all the fractures were addressed with internal fixation during the primary surgery. Postoperatively, the patient suffered a dislocation of the femoral head which eventually went on to avascular necrosis at 5 months from the initial presentation. Then, the patient underwent a total hip replacement with an acetabular reconstruction following which he went on to have a good functional outcome. Our experience in dealing with such a complex case shows that it is difficult to set a protocol for such injuries and they need to be addressed on a case-to-case basis depending on the complexity of the injury.

Concurrent ipsilateral fractures of acetabular posterior wall and femoral shaft associated with posterior hip dislocation: A case report and literature review of a rare injury

“…In the first most similar case, Rajasekaran and colleagues reported a 52-year-old male farmer who had a high-energy road traffic accident 7 h before admission and was resuscitated according to the advanced trauma life support protocols and was stable at the time of referral [ 5 ]. In radiologic examinations, the patient had a posterior acetabular wall fracture, ipsilateral femoral neck fracture and hip dislocation, and a middle third femoral shaft fracture on the left side.…”

“…Although a variety of combinations of injuries in the floating hip have been reported in the literature, the presence of hip dislocation, besides the mentioned fractures, is a rare phenomenon that is reported in only a few studies [ [5] , [6] , [7] ]. The importance of such a combination of injuries is the challenge of reducing hip, which is vital to save the neurovascular compartments of the lower extremity and prevent adverse outcomes like avascular necrosis (AVN) of the femoral head [ 8 ] and seems to be difficult and even impossible in some cases [ 7 ].…”

Simultaneous Ipsilateral “Floating Hip” with Hip Dislocation and Femoral Neck and Shaft Fractures Associated with “Floating Knee” Injuries with Patella Fracture and Traumatic Sciatic Nerve Injury

“…Most of the other delays were due to the need for an appropriately experienced surgeon to be available. Simultaneous ipsilateral "floating-hip" and "floating-knee" injuries represent a great challenge and require extensive surgical experience, careful planning, and teamwork because there are no special protocols for the treatment of serious injuries such as these [1]. The complexity of our injury was severe, and such injuries have shown to be associated with a high chance of osteonecrosis of the femoral head.…”

“…These injuries can be life-threatening, and many complications can occur during and after treatment. Simultaneous ipsilateral "floating-hip" and "floating-knee" injuries represent a great challenge and require extensive surgical experience, careful planning, and teamwork because there are no special protocols for the treatment of serious injuries such as these [1][2][3][4].…”

Concomitant ipsilateral acetabular and femoral fractures – an appraisal of outcomes and complications in 34 patients

“…While it is accepted that these patients require surgical intervention, there are areas where consensus is lacking. This is because these are uncommon injuries that are reported as case-reports and case series (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Information on the mechanism and type of fractures, sequence of fixation, outcomes, and complications of these injuries is limited (1,3,(5)(6)(7).…”