Background: Neglected traumatic hip dislocations, is relatively common in developing countries. This poses significant management challenges, particularly in young adults. Delayed presentations often result in severe fibrosis and muscle contractures, complicating surgical intervention and increasing the risk of Avascular Necrosis (AVN) of the femoral head. 

Case Presentation: A 31-year-old male presented with a neglected hip dislocation 6 weeks post-road traffic accident. The delay in treatment was attributed to COVID-19-related surgical protocols. Initial examination revealed a 3.5 cm leg length discrepancy but preserved ankle and toe dorsiflexion without neurovascular deficits. 

Method: The patient underwent open reduction using the Trochanteric Digastric Hip Osteotomy (TDHO) technique, which provides extensive joint exposure while preserving the vascular supply to the femoral head. The surgical approach included a trochanteric osteotomy to enhance visualization and facilitate joint reduction. 

Results: Postoperative rehabilitation led to a Harris Hip Score (HHS) of 90 at 12 weeks, and MRI at 1 year post-operation showed no evidence of AVN. The patient achieved pre-injury ambulatory status without pain. 

Discussion: Based on Ganz’s principles of safe surgical dislocation, effectively addresses the challenges of neglected hip dislocations. By maintaining the medial femoral circumflex artery (MFCA) supply and avoiding extensive disruption of external rotators, this approach reduces the risk of AVN and promotes favorable outcomes. 

Conclusion: For neglected hip dislocations, the Trochanteric Digastric Hip Osteotomy (TDHO) proves to be a viable and effective surgical strategy. It preserves femoral head vascularity and achieves excellent functional outcomes, as demonstrated by the case presented.

Niko Augustine R Abella, 32, is the current chief resident in orthopedic surgery, now in his fourth year, and is expected to graduate in December 2024. He plans to pursue a fellowship in traumatology and hip and knee arthroplasty overseas following the completion of his residency.