Case history
Preoperative management
The patient is a 35-year-old male with no past medical history who presented to our institution after sustaining a single GSW to the right hip during a home invasion two weeks ago. He was undergone laparotomy emergently and after stabilizing him, the patient sustained to our center. Physical examination revealed an open ballistic wound to the posterior hip and right sciatic nerve deficit. Radiographs (Fig. 1) and computerized tomography (CT) scans (Fig. 2 and Fig. 3) of the pelvis and hip were obtained, which demonstrated a comminuted fracture of the femoral head, along with comminuted fracture of both acetabular columns. Three-dimensional CT reconstruction images were acquired to further characterize the femoral head and acetabular fracture fragments. Associated injuries such as bowels and bladder were managed via general surgery and urology services as well.
Operation
After discussing the risks and complications of operative treatment, informed consent was obtained, and the patient was taken to the operating room.
A kocher-langenbeck approach was used for exposure. We decided to explore and neurolyse the sciatic nerve and use just a 3.5 mm reconstruction posterior column buttress plate in order to do the total hip arthroplasty (THA) after bone union along with irrigation and debridement (Fig. 4).
After a year bone union was completed, and laboratory data showed no evidence of infection. The pre-op harris hip score (HHS) was 22. In this stage THA was done through lateral approach. After dislocating the hip joint anteriorly, the hip was taken into a position of flexion, adduction, and external rotation to deliver the femoral neck osteotomy into the anterior aspect of the exposure and resecting the femoral head residues. Then the acetabulum was prepared and a 52mm Zimmer Biomet continuum cup was implanted with a 36 mm linear. The femoral canal was prepared, and after trialing, a 16/225-mm Zimmer Biomet wagner SL press-fit femoral stem was implanted with a metal Zimmer Biomet 36 mm head and -3.5 mm neck length. The hip was then reduced with satisfactory stability and soft-tissue tension were obtained. The exposure was then closed in standard fashion. Standard radiographs were obtained immediately after the operation (Fig. 5)
Postoperative care
He was made touch-down weight-bearing for 6 weeks and then allowed to advance as tolerated. The physical therapy team was consulted postoperatively for mobilization, and global hip precautions were provided as this patient had a dual approach. No heterotopic ossification prophylaxis was utilized. At one-year postoperatively, the patient returned for a follow-up visit and Radiographs were obtained at this time for routine monitoring and to confirm proper positioning of hardware (Fig. 6). He had no complaints and the HHS was 74.