Osteosynthesis in Iatrogenic Femoral Neck Fracture following Irreducible Posterior Hip Fracture Dislocation in an Elderly Patient: A Case Report and Literature Review.

Introduction: Iatrogenic femoral neck fractures following attempted closed reduction of irreducible posterior hip dislocations are extremely rare and underreported. This case highlights the importance of pre-reduction evaluation and presents the first known report of successful osteosynthesis in an elderly patient. Case Report: A 55-year-old Indian female presented with a posterior hip dislocation and femoral head fracture (Pipkin type I) following a road traffic accident. During attempted closed reduction, an audible crack was noted. Imaging revealed an iatrogenic femoral neck fracture, converting the injury to a Pipkin type III configuration. The patient underwent open reduction and internal fixation using a modified Gibson approach and Ganz trochanteric osteotomy. Post-operative rehabilitation included staged weight-bearing and physical therapy. The patient achieved fracture union with an excellent Harris Hip Score of 96.8 at 18 months of follow-up. Conclusion: This is the first reported case demonstrating successful osteosynthesis in a Pipkin type III fracture-dislocation due to an iatrogenic neck fracture in an elderly patient. The case emphasizes the role of thorough assessment before reduction and the feasibility of head preservation techniques even in elderly patients with good bone stock.