Acute Primary Total Hip Arthroplasty Combined with Open Reduction and Internal Fixation of the Posterior Acetabular Wall for Ipsilateral Femoral Neck Fracture Following a High-energy Fall: A Case Report

Abstract

Aims: To report a rare case of combined ipsilateral femoral neck fracture and posterior acetabular wall fracture following a high-energy fall, managed acutely with simultaneous open reduction and internal fixation (ORIF) of the posterior acetabular wall and total hip arthroplasty (THA) via a Kocher-Langenbeck approach. Presentation of Case: A 49-year-old male with no significant past medical history presented after a 3-metre fall and sustained a comminuted right distal radius fracture, managed with an external fixator at admission, together with an ipsilateral femoral neck fracture and posterior acetabular wall fracture. The patient underwent acute primary uncemented THA combined with posterior acetabular wall fixation using a reconstruction plate via a Kocher-Langenbeck approach in a single surgical session. At 12-month follow-up, the patient demonstrated satisfactory functional recovery with stable implant fixation, no evidence of loosening, osteolysis or dislocation, and progressive return to daily activities, with a Harris Hip Score of 88 (compared with 42 in the immediate postoperative period) and a pain-free hip range of motion of 0–100° flexion. Discussion: This injury combination is rare and surgically challenging. Simultaneous ORIF of the acetabular wall and acute THA may avoid the risks of avascular necrosis, non-union and secondary arthroplasty procedures associated with isolated osteosynthesis of such complex fracture patterns. Conclusion: Acute primary THA combined with posterior acetabular wall fixation is a viable one-stage surgical solution in selected patients with ipsilateral femoral neck and posterior acetabular wall fractures following high-energy trauma, enabling early functional recovery and avoiding staged procedures.