Concomitant Posterior Hip Dislocation, Ipsilateral Intertrochanteric- and Proximal Tibial- Fractures with Popliteal Artery Injury: A Challenging Trauma Mélange

Abstract

Constellation of ipsilateral posterior hip dislocation, intertrochanteric- and proximal tibial fracture with popliteal artery injury is rare. Management of this presentation is challenging. A motor vehicle accident victim presented with these injuries, but without any initial signs of vascular compromise. Popliteal artery injury was diagnosed intra-operatively and repaired. This was followed by external fixation of tibial fracture, open reduction of dislocated hip and internal fixation of intertrochanteric fracture. Patient regained bilateral complete weight bearing and returned to pre-accident activity level. Apt surgical management including early repair of vascular injury in such a trauma mélange allows for a positive postoperative outcome.

Keywords: Posterior hip dislocation; intertrochanteric fracture; popliteal artery injury.

Figure 1.

A) Axial view of left hip on computed tomography scan confirming posterior hip dislocation with ipsilateral inter-trochanteric fracture. B) 3D Reconstruction of left hip demonstrating the posterior dislocation with ipsilateral inter-trochanteric fracture. C) Left knee radiograph demonstrating the oblique proximal tibia fracture. D) Left proximal tibia fracture stabilized with external fixator.

Figure 2.

A) Left knee radiograph after external fixator removal and B) left hip radiograph on 12 month follow-up showing no signs of osteonecrosis femoral head or post-traumatic arthritis of hip joint.

Figure 3.

A) Left knee anteroposterior and B) lateral radiograph at 16 month follow-up showing satisfactory reduction and union following the bone graft and plate repair of the left proximal tibial non-union.