Neglected hip fracture dislocation in young adult treated with total hip arthroplasty and bone graft

Background: Hip fractures is estimated to occur in 176/100.000 population in Indonesia. Inadequate treatment or over negligence of hip fractures will result in significant morbidity. Bone graft can be added to support acetabular bone loss but the concept is still early. Here presented a unique neglected cases of hip fracture dislocation, treated with Total Hip Arthroplasty (THA) augmented with bone graft. Case Report: A-26-year-old female came to the outpatient clinic with chief complaint of pain on left hip. The pain intensified the last two weeks on her left hip and worsens upon weight-bearing. The patient has had a motor vehicle accident 8 months ago where her hip was not treated due to lack of funding. On physical examination, pain on palpation and limited ROM was observed. The patient was then planned for THA with posterior approach. Acetabular bone loss was filled with bone graft. Postoperative, the patient regained her walking capability and the pain subsided. Postoperative hip radiograph showed an optimally placed acetabular implant with inclination of 36.1o on the normal side and 42.3o on the THA side, CORA (center of rotation angulation) 100 mm on the normal side and 99 mm on the THA side from midline, and 79 mm on the normal side and 81 mm on the THA side from trans sacrogluteal line. Discussion: Few literatures describe neglected hip fracture dislocation cases. Neglected hip fracture dislocation causing joint incongruity and cartilage damage, with osteoarthritis risk increased. Some authors described THA as a treatment of choice. Type of surgical treatment, approach, and implants needs to be adjusted to the patient’s lifestyle and condition to achieve satisfactory result. Posterior approach has the advantage of being able to directly access the fracture dislocation site. Bone grafting can be used in THA as a structural buttress. In this case, femoral head was used to augment posterior column and acetabular wall. Cementless acetabular implant is the treatment of choice for young patients. Conclusion: Total hip arthroplasty augmented with bone graft is a viable and recommended treatment option for neglected hip fractures or hip fractures in general.