Year: 2025 | Month: September | Volume: 12 | Issue: 9 | Pages: 1-6
DOI: https://doi.org/10.52403/ijrr.20250901
Application of Girdlestone Procedure in Neglected Hip Dislocation with Ipsilateral Femoral Shaft Malunion: A Case Report
Nugraha Ramadhan1, I Wayan Subawa2
1Resident of Orthopaedic and Traumatology, Faculty of Medicine, Udayana University, Prof Ngoerah Hospital, Bali, Indonesia
2Department of Orthopaedic and Traumatology, Faculty of Medicine, Udayana University, Prof Ngoerah Hospital, Bali, Indonesia
Corresponding Author: Nugraha Ramadhan
ABSTRACT
Introduction: Neglected hip dislocation is a rare but serious orthopedic condition, typically resulting from high-energy trauma and commonly associated with other skeletal injuries. If left untreated, the dislocated hip undergoes progressive anatomical distortion, leading to chronic pain, deformity, and loss of function. Management becomes especially complex when the dislocation coexists with a malunited femoral shaft fracture. In such cases, conventional reconstructive procedures may be challenging or infeasible. The Girdlestone procedure, or femoral head excision arthroplasty, although traditionally reserved for elderly or low-demand patients, may serve as a valuable option in select young adults with complex neglected injuries.
Case Presentation: We report the case of a 22-year-old female university student who presented with persistent pain and restricted mobility in the left hip and thigh, one year following a motorcycle accident. She had declined initial treatment due to fear of surgical intervention and self-managed with analgesics. On evaluation, she exhibited signs of a neglected posterior hip dislocation and malunited left femoral shaft fracture. A staged surgical approach was adopted. The first procedure involved open reduction via ilioinguinal approach and excision of the deformed femoral head using a Girdlestone technique, followed by skeletal traction for alignment. In the second stage, performed eight months later, osteotomy and internal fixation with a 9-hole broad locking plate and screws were carried out to correct femoral malalignment. The patient demonstrated significant pain relief and progressive improvement in mobility postoperatively.
Discussion: Neglected hip dislocations in young adults are uncommon and present unique challenges due to extensive joint remodeling and associated injuries. The Girdlestone procedure, while not typically first-line in young patients, provided effective joint decompression and pain relief in this complex case. It also enabled staged correction of femoral deformity and preserved the potential for future reconstructive options. This case supports the role of excision arthroplasty as a temporizing or definitive treatment in young patients with severe anatomical distortion and delayed presentation.
Conclusion: In carefully selected cases, the Girdlestone procedure can serve as a viable salvage technique for managing neglected hip dislocation in young adults, especially when conventional reconstruction is not immediately feasible. This case underscores the importance of individualized surgical planning and staged intervention to restore function and improve patient outcomes.
Keywords: Hip Dislocation, Femoral Fractures. Arthroplasty, Excision, Orthopedic Procedures, Delayed Diagnosis
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