Acetabular fracture with acute pelvic discontinuity followin
An 81-year-old woman presented with a chief complaint of left hip pain and inability to bear weight. She had undergone left total hip arthroplasty revision surgery 6 weeks previously to address polyethylene wear of her index THA performed 20 years prior to presentation. The patient was noted to have a protrusio prior to her revision surgery with violation of the medial wall, however her revision surgeon was able to perform an appropriate acetabular revision by using a multi-hole shell.

During her rehabilitation from that surgery, the patient sustained a fall and subsequently developed severe left hip pain with any attempt at weight-bearing. She was subsequently referred to our practice for further evaluation and management.

Her past medical history was significant for prior myocardial infarction status post-coronary artery bypass grafting, paroxysmal atrial fibrillation status post-pacemaker placement and associated congestive heart failure. She was managed by a pulmonologist for COPD and required home oxygen. Her past surgical history included the aforementioned CABG and pacemaker placement, as well as left THA 20 years prior to presentation and left hip revision THA 6 weeks prior to presentation. She also underwent cervical and lumbar fusions, and abdominal hernia repair.

Range of motion at the left hip was limited secondary to pain, but was otherwise normal in the other joints of the ipsilateral and contralateral lower extremities. The patient was intact on motor and sensory examination and had palpable pedal pulses bilaterally. Postoperative anteroposterior (AP) and lateral plain radiographs obtained after her left hip revision THA were compared to new films taken after her fall.

Given the complexity of her injury, as well as her medical history, a substantial discussion was had regarding the various treatment options, such as open reduction internal fixation (ORIF) with revision arthroplasty or girdlestone procedure.

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