Anterior Smith-Petersen approach with lateral plating treated pediatric posterior hip dislocation with femoral shaft fracture

BackgroundTraumatic hip dislocation combined with an ipsilateral femoral shaft fracture is an extremely rare and severe injury, particularly in children, with an annual incidence of traumatic joint dislocations around 1 per 100,000 in pediatric populations. The absence of a femoral lever arm complicates reduction, often requiring open techniques. While posterior approaches are traditional for posterior dislocations, they risk further compromising the femoral head's blood supply in pediatric patients.Case presentationWe report a 10-year-old boy who sustained a high-energy injury leading to posterior dislocation of the right hip and an ipsilateral displaced femoral shaft fracture. Treatment involved open reduction via the anterior Smith-Petersen (S-P) approach to safeguard posterior vascularity, combined with lateral plating of the femur. At 18-month follow-up, the patient achieved full weight-bearing, complete range of motion, solid femoral union, a congruent hip joint, and no evidence of avascular necrosis (AVN) or leg-length discrepancy.ConclusionIn pediatric cases of this complex injury, anterior open reduction paired with rigid femoral fixation offers a safe and effective option. It enables anatomic reduction while potentially reducing iatrogenic damage to the medial circumflex femoral artery, thereby lowering AVN risk, which can increase over fivefold with delays beyond 12 h.