Primary complex total hip replacement in 13 months old neglected Pelvi-acetabular fracture

Abstract

Old pelvi-acetabular fracture are very difficult to operate in terms of achievement of anatomical reduction. Although two staged procedures are still treatment of choice(first stage acetabular osteosynthesis then THR if complication occurs) but neglected cases(more than 3 weeks old untreated fractures)can also treated by total hip replacement. Our case is A 35 years old patient sustained railway traffic accident. He had crush injury left lower limb severe abdominal and chest trauma, bilateral sacroiliac join disruption, iliac wing fracture left side and pelvi-acetabular fracture right side.at that time patient was treated at other hospital where above knee amputation of left lower limb done, abdominal and chest injury managed but pelvi-acetabular fracture was treated conservatively. After 1 year patient presented to us with pain and restriction of movement of right hip and inability to sit also. we performed primary complex total hip replacement using multi-hole acetabular cup and un-cemented femoral stem with metal on ultra high molecular polyethylene bearing and bone graft. results are satisfactory with fair range of motion at hip and modfied harris hip score. So primary complex total hip replacement is viable option for old pelvi-acetabular fracture cases where anatomical and biological reduction of fracture is not possible.