International Journal of Research in Orthopaedics | January-February 2022 | Vol 8 | Issue 1 Page 106 International Journal of Research in Orthopaedics Raj P et al. Int J Res Orthop. 2022 Jan;8(1):106-109 http://www.ijoro.org Case Report Restoration of neglected fracture dislocation hip in elderly: a case report Praveen Raj*, Kaustav Mukherjee, Gokul Raj Dhanraj, Sundararaja Bhaskar, Pradeep Jayaram Purushothaman INTRODUCTION Neglected traumatic fracture dislocations of the hip are quite rarely found in elderly and such injuries are mostly from high energy trauma. These types of fractures are often associated with a head injury, abdominal trauma, ipsilateral or contralateral limb musculoskeletal injuries which may detract attention from these underlying fractures and as a result often missed at initial evaluation. 1 Femoral head fractures account for only 7-16% of all hip fracture dislocations, with combined femoral head and acetabular fractures incidence being even lower. 2 There is no clear consensus on management of these type of fracture dislocations in elderly population. They occur as a shearing injury when the flexed femoral head is forced on the posterior wall of the acetabulum causing fracture dislocation/subluxation. 3 Neglected hip fracture subluxation/dislocations occur when the patient does not or cannot seek adequate medical care. 4 Moreover, in developing countries, indigenous treatments still exist causing further delay in treatment of these fractures. Treatment of neglected dislocation of the hip becomes difficult with time due to soft tissue contractures, adhesions, fibro fatty tissue filling of acetabulum and presence of myositis ossificans. 5 Apart from difficulty in reduction, there are also high chances of avascular necrosis and arthritis. Recent literature favours primary hip replacement as compared to open reduction and internal fixation in age above 55-60 years and in patients with neglected hip fracture dislocations of more than 3 months duration due to high chances of afore mentioned complications. 6-8 Here, we report an elderly male who presented to us for a neglected hip posterior dislocation with associated posterior acetabulum wall and femoral head fracture who underwent a total hip replacement. ABSTRACT Neglected traumatic fracture dislocation of the hip is a challenging problem due to soft tissue contractures, adhesions, fibro fatty tissue filling acetabulum, avascular necrosis, arthritis and myositis ossificans. These types of injury often get missed at initial evaluation in the presence of distracting injuries and in poly trauma patients. Femoral head fractures account for only 7-16% of all hip fracture dislocations, with combined femoral head and acetabular fractures in elderly being even lower. Literature favours primary hip replacement as compared to hip salvage in age above 60 years and in patients with neglected hip fracture dislocations of more than 3 months duration due to high chances of afore mentioned complications. Here, we report a case of 69 years old male with neglected hip fracture dislocation associated with posterior acetabular wall and femoral head fracture for the challenges in management with a total hip replacement. Keywords: Neglected, Hip fracture dislocation, Femoral head fracture, Total hip replacement Sri Ramachandra Institute of Higher Education, Chennai, Tamil Nadu, India Received: 25 October 2021 Accepted: 01 December 2021 *Correspondence: Dr. Praveen Raj, E-mail: praveen.raj.473@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20214972