Concurrent Posterosuperior Hip Dislocation and Ipsilateral Diaphyseal Femoral Fracture: Staged Surgical Management and Twelve-Month Outcome

Abstract

Background: Concurrent posterosuperior hip dislocation with ipsilateral femoral diaphyseal fracture is a rare, high-energy orthopaedic injury in which the femoral shaft fracture may mask the associated hip dislocation, increasing the risk of delayed reduction and femoral head vascular compromise. Case Presentation: A 54-year-old previously healthy male pedestrian presented to the emergency department at 21:30 hours after being struck by a motorcycle. Examination showed shortening, external rotation, inability to bear weight, and intact distal neurovascular status. Radiographs confirmed a closed right mid-diaphyseal femoral fracture with concurrent right posterosuperior hip dislocation, without plain radiographic evidence of femoral neck or posterior acetabular wall fracture. Urgent closed reduction was performed under general anaesthesia using a modified Allis technique, with the proximal femoral fragment used as a traction handle because shaft continuity was lost. Fluoroscopy confirmed concentric reduction. Definitive fixation of the femoral shaft fracture was then completed in the same operative session using an antegrade centromedullary interlocking nail. Outcome: Rehabilitation progressed from initial non-weight-bearing mobilisation to partial weight-bearing at 6 weeks and full weight-bearing at 12 weeks. At twelve months, radiographs showed complete femoral fracture consolidation, preserved femoral head sphericity, and no radiographic evidence of avascular necrosis. The Harris Hip Score was 91. Conclusion: This case supports systematic pelvic imaging in high-energy femoral fractures and prioritisation of urgent hip reduction before definitive fracture fixation.