Decision-Making in Complex-Fracture Dislocation of the Hip with Acetabulum Involvement and Sciatic Nerve Palsy

Introduction: An uncommon fracture pattern involves a complex posterior hip dislocation with fractures of the acetabulum and femur neck, accompanied by sciatic nerve palsy. These injuries present with management issues because they are linked to high-velocity trauma. The choice between hip replacement and preservation procedures for middle-aged individuals is controversial. The risks associated with fixation include avascular necrosis (AVN), post-traumatic osteoarthritis, and non-union in the hip necessitating a subsequent total hip replacement (THR) Case Report: : Following a high-velocity trauma, a 33-year-old male patient came to us with complex posterior hip dislocation with acetabulum and femur neck fracture and sciatic nerve palsy. He underwent implant-assisted acetabular reconstruction, sciatic nerve decompression, and acute primary uncemented total hip arthroplasty (THA). After 1-year, sciatic nerve recovery was observed thus allowing him to perform his everyday activities with normal locomotion. Conclusion: :Complex posterior hip dislocation with acetabulum and femur neck fracture and sciatic nerve palsy managed with acetabular reconstruction with sciatic nerve exploration and primary THR is a feasible therapeutic option compared to osteosynthesis, despite its rarity. This makes it easier to recover from surgery and prevents additional procedures in case AVN or secondary arthritis develops.