Ischiatic Dislocation of the Hip Associated with an Ipsilateral Femoral Shaft Fracture: A Case Report and Literature Review

Abstract

Introduction: Ischiatic dislocation of the hip associated with an ipsilateral femoral shaft fracture is unusual. It represents a real therapeutic challenge. Case Report: We report the case of a 26-year-old drug-addicted patient who fell from the 4th floor. This fall resulted in severe polytrauma, with an ischiatic dislocation of the left hip associated with a fracture of the left femoral shaft, besides a displaced open fracture of the left humerus, a fracture of the medial malleolus, a fracture of the calcaneum and a fracture of the sacrum. An emergency reduction of the hip dislocation was performed 3 hours after admission to the operating room by external manoeuvres of the hip dislocation. Osteosynthesis of other lesions was performed 24 hours after the patient’s hemodynamic and respiratory stability with the anterograde femoral nail. Early mobilisation of the limb joints without full weight bearing for up to 2 months. The patient returned to his professional activity pre-injury after 4 months.   At a 2-year follow-up postoperatively. The patient considered the evolution satisfactory. X-rays noted good consolidation of the fractures. There was no evidence of avascular necrosis on radiographs after 2 years.   Conclusion: The combined injury of a femoral shaft fracture with a homolateral ischiatic dislocation of the hip is extremely rare. The emergency in an unstable patient with femoral head dislocation is the reduction of the femoral head to minimise the risk of avascular necrosis in the young adult.