Traumatic gluteus maximus femoral insertion tear

Abstract

With hip fracture dislocation, there is a wide variety of injuries, and one of the least and rarely to be seen is a gluteus maximus femoral insertion tear. We report this case to encourage further sharing of similar cases, establish a treatment protocol, and avoid such potential complications. We present this rare case of a 36-year-old male, a victim of a severe motor vehicle collision, who presented with a head contusion, right gluteus maximus femoral insertion tear, right hip dislocation with closed posterior wall acetabulum fracture, intra-articular incarcerated fragment, and multiple fractures. After the reduction of his hip and splinting of his concomitant fractures and optimization of the general condition, he underwent open reduction internal fixation of the posterior acetabulum wall. Intraoperatively, he found to have a rupture of gluteus maximus and short external rotators for which he had gluteus maximus direct repair to its insertion and partial repair for his severely damaged external rotators. The patient developed a surgical site infection post operation, treated by multiple sessions of irrigation and debridement and culture-based intravenous venous antibiotics for six weeks. At the 7-month outpatient clinical follow-up, the patient function was able to mobilize with a limping gait using a cane and extreme limitation of his abduction, external rotation, and extension due to the development of heterotopic ossification, which could be due to prolonged intensive care unit admission due to head injury or hip external rotators rupture or multiple surgeries that he underwent. This rare finding of gluteus maximus ruptur is the first of a kind in our institute, and such a finding to be considered before treatment of such severe injuries and questioning the need for magnetic resonance imaging for traumatic hip dislocations plus prophylactic treatment of heterotopic ossification to optimize the functional outcome post-operative.