Central Fracture-Dislocation of the Hip with Ipsilateral Femoral Neck Fracture in an Elderly Patient with Parkinsonism Managed with Dual Mobility Total Hip Arthroplasty: A Case Report and Review of Literature.

Introduction: The combination of a central fracture-dislocation of the hip, acetabulum fracture, and neck of the femur fracture is a rare injury, with a few reports described in the literature. Guidelines regarding managing this type of injury in single or multiple stages, the requirement of acetabular augmentation with plates, metal rings or cages, and the implant selection in elderly patients are not adequately defined while planning a total hip arthroplasty (THA). The successful management of such a complex fracture pattern in an elderly patient with neurodegenerative disorder is described in our case report.

Case Report: An 81-year-old male presented to our outpatient department with a 2-month-old neglected post-traumatic central fracturedislocation of the right hip with an ipsilateral femoral neck fracture. The patient had a known case of Parkinson's disease on treatment with oral medication. A single-stage hybrid THA with dual mobility (DM) prosthesis was done with femoral head autograft acetabular impaction bone grafting. The patient was mobilized full weight bearing with the support of a walker on the 2nd post-operative day. At the 1-year follow-up the functional Harris hip score was 87. Radiographs revealed a well-healed acetabular fracture with the incorporation of a bone graft. No signs of implant loosening were observed. We did not encounter any complications such as dislocation, infection, and heterotrophic ossificans.

Conclusion: Management of central fracture-dislocation of the hip with delayed one-staged THA has a good functional outcome. DM cup is essential in patients with parkinsonism and other neurodegenerative disorders.