The irreducible floating hip: a unique presentation of a rare injury
A 35-year-old male was involved in a high-speed urban dirt biking accident. The patient was stable with a GCS of 15 and was neurovascularly intact. His left knee exhibited a 10 × 20 cm medial traumatic arthrotomy and his thigh compartments were soft and compressible. Imaging revealed a left hip postero-superior dislocation, posterior wall acetabular fracture, ipsilateral transverse femoral diaphyseal fracture and an engaging hill-sachs-type lesion of the femoral head with the postero-superior acetabulum (Figs –). Cefazolin, gentamicin and tetanus prophylaxis were administered along with a bedside washout of the traumatic arthrotomy. The patient was medically cleared for operative intervention as all blood work and further imaging were normal.\nOperative management focused on closed reduction of the dislocated left hip. Two 5.0 mm Schanz pins with a carbon fiber bar (Zimmer, Warsaw, Indiana, USA) were placed in the proximal femur fragment. This was used to aid with the closed reduction maneuver of knee flexion, hip traction, adduction and internal rotation. Confirmed by intra-operative fluoroscopy, the femoral head was irreducible due to the engaging femoral head lesion on the acetabulum. A conversion to open reduction via a Kocher–Langenbeck approach in the lateral position ensued. The femoral head and posterior wall were reduced under direct visualization with two 3.5 mm pelvic reconstruction plates (Zimmer). The patient was moved to the supine position and underwent definitive femoral fixation with a retrograde, reamed femoral nail (Zimmer). Thigh compartments at the conclusion of the femoral fixation were tense and non-compressible, requiring a thigh compartment fasciotomy. Negative pressure therapy was placed over the incision and the knee laceration was primarily closed. After multiple washouts of his lateral fasciotomy incision, he was primarily closed 1 week after initial presentation. He was discharged non-weight bearing on his left lower extremity on post-operative day 22. Eleven months post-injury, he remains full weight bearing without assistance. He reports intermittent pain with ambulation and radiographs show early arthritic changes and heterotopic ossification of his left hip (Fig. ).