Traumatic Pubic-type Anterior Dislocation of the Hip with an Ipsilateral Greater Trochanter Fracture: Case Report and Review of Literature

Abstract

Due to the inherent stability of the hip joint, hip dislocations constitute a relatively small proportion of all the traumatic dislocations encountered in the emergency department. Among them, the anterior type of hip dislocation is less common than the posterior type of dislocation. Anterior dislocations are usually associated with an injury to other, nearby structures like the acetabulum and femoral head. An ipsilateral greater trochanter fracture with anterior hip dislocation is very sparsely reported in the literature. We report the case of a pubic type of anterior hip dislocation associated with a concomitant ipsilateral greater trochanter fracture. The joint was reduced promptly with traction-countertraction under sedation, and the associated fracture was subsequently fixed with two 6.5 mm partially threaded, cannulated, cancellous screws. The patient was symptom-free at the last follow-up of one year with a full range of hip joint motion, and without any evidence of osteonecrosis or osteoarthritis. The mechanism of greater trochanter fracture in such injuries and its management has been discussed.

Keywords: anterior hip dislocation; fracture dislocation of hip; greater trochanter fracture; hip trauma; osteonecrosis; pubic dislocation.

Figure 1. Computed tomography (CT) scan of the pelvis with three-dimensional (3D) reconstruction from the anterior aspect (A) and right lateral aspect (B)

Pubic-type anterior dislocation of the right hip with ipsilateral displaced greater trochanter fracture (white arrows).

Figure 2. Post-operative plain radiograph of the pelvis with bilateral hips – anteroposterior view

Fixation of greater trochanter fracture with two 6.5 mm cannulated cancellous screws with washer, along with congruent reduction of the right hip joint.