Acetabular fractures adjacent to heterotopic renal allografts: report of two cases managed with delayed total hip replacement

Kidney transplantation is increasingly performed, with grafts commonly placed in the iliac fossa. This anatomical configuration poses significant challenges in the management of ipsilateral acetabular fractures, particularly in elderly patients with poor bone quality and complex fracture patterns. In such cases, achieving orthopaedic stability while preserving graft function requires careful clinical judgment. We present two cases of elderly renal transplant recipients who sustained acetabular fractures on the same side as their intrapelvic graft. Conservative management was initially selected due to multiple comorbidities, severe osteoporosis, and adverse radiographic indicators such as the "gull sign". Both patients later developed post-traumatic arthritis and functional deterioration, ultimately requiring delayed total hip arthroplasty. Renal graft function remained stable throughout the clinical course, and no adjustments to immunosuppressive therapy were necessary. To minimize the risk of graft injury, anterior surgical approaches were avoided. Delayed arthroplasty following fracture consolidation allowed the use of standard implants without compromising graft integrity. This approach appears to be a safe and effective alternative when open reduction is contraindicated.