Morphology-Guided Surgical Management of Complex Traumatic Hip Fracture-Dislocations and Acetabular Fractures: A Six-Case Series Illustrating Morphology-Based Surgical Approaches.

Traumatic hip fracture-dislocations and complex acetabular fractures are uncommon but severe injuries caused by high-energy trauma that require prompt diagnosis and individualized surgical management. Although emergency reduction is essential for hip dislocations, definitive treatment depends on fracture morphology. This case series illustrates how fracture morphology can guide individualized operative planning in complex traumatic hip and acetabular injuries. We present six patients with distinct traumatic hip fracture-dislocations and acetabular fracture patterns, each managed using an individualized surgical approach according to the underlying fracture morphology. The first patient was a 26-year-old male with a central hip fracture-dislocation associated with fractures of the anterior column, quadrilateral surface, iliac blade, and an undisplaced posterior column, managed through the modified Stoppa approach following prophylactic ligation of the corona mortis. The second patient was a 19-year-old male who presented with a posterior hip dislocation associated with a Pipkin type II femoral head fracture and underwent fixation through the Ganz safe surgical dislocation approach with trochanteric flip osteotomy. The third patient was a 25-year-old male with a posterior hip dislocation associated with a posterior wall acetabular fracture, treated through the Kocher-Langenbeck approach using spring plates and posterior reconstruction plating. The fourth patient was a 38-year-old female with a complex both-column acetabular fracture (AO/OTA type 62-C3), managed with a combined anterior and posterior approach and sequential reconstruction of the anterior column, posterior column, and quadrilateral surface. The fifth patient was a 22-year-old male with a both-column acetabular fracture (AO/OTA type 62-C1), treated using the modified Stoppa approach with the first window of the ilioinguinal approach, allowing stable fixation of the pelvic brim, quadrilateral surface, and posterior column. The sixth patient was a 45-year-old male with an associated anterior and posterior column acetabular fracture managed through the Ganz safe surgical dislocation approach with trochanteric flip osteotomy, enabling direct visualization of the posterior acetabulum and anatomical reconstruction while preserving femoral head vascularity. Computed tomography with three-dimensional reconstruction accurately defined fracture morphology and guided surgical planning. Surgical exposure was individualized according to fracture configuration, with anatomical reduction, stable fixation, satisfactory radiological alignment, and clinical recovery documented in all patients. This six-case series demonstrates that traumatic hip fracture-dislocations and complex acetabular fractures comprise a heterogeneous spectrum of injuries requiring individualized surgical management. Careful CT-based assessment and morphology-guided selection of the surgical approach facilitated appropriate exposure, anatomical reconstruction, and stable fixation in these cases. The modified Stoppa, Ganz safe surgical dislocation, Kocher-Langenbeck, combined anterior and posterior, and modified Stoppa with the first window of the ilioinguinal approaches each provided effective management for specific fracture patterns. These cases illustrate the feasibility of morphology-guided operative planning with satisfactory radiological and clinical outcomes.