Asymmetric bilateral traumatic hip dislocation: Report of two cases

Background: Bilateral traumatic hip dislocation is a rare and severe orthopedic injury that is typically associated with high-energy trauma. Asymmetric bilateral dislocations are particularly uncommon and may pose diagnostic challenges, especially when presentation or evaluation is delayed. Case Presentation: We report the case of a patient who sustained asymmetric bilateral traumatic hip dislocation following a high-energy road traffic accident. The patient presented with severe bilateral hip pain and inability to bear weight. Due to delayed diagnosis, orthopedic evaluation occurred more than nine hours after presentation. Imaging revealed anterior dislocation of the right hip and posterior dislocation of the left hip. Closed reduction of both hips was successfully performed under conscious sedation. On examination, the patient demonstrated left-sided foot drop consistent with sciatic nerve involvement. Post-reduction imaging confirmed concentric reduction of both hips. Conclusion: This case highlights the diagnostic challenges associated with asymmetric bilateral traumatic hip dislocation and underscores the importance of early recognition, comprehensive trauma assessment, and timely reduction to minimize complications such as avascular necrosis and neurological injury. Reporting such rare presentations contributes to increased clinical awareness and reinforces key principles in the management of traumatic hip dislocations.

Traumatic dislocation of the hip joint is a rare injury representing 2%–5% of all dislocations while bilateral hip dislocation accounts for 1.25% of all hip dislocations. Asymmetrical hip dislocations are even rarer accounting for approximately 0.01%–0.02% of all hip joint dislocations. We are reporting a case of bilateral asymmetrical hip dislocations with left-sided posterior dislocation and right anterior dislocation in a 70-year-old female following a road traffic accident. It is pertinent to thoroughly evaluate the patient on the Advanced Trauma Life Support guidelines. After evaluation, it is vital to reduce hip dislocation within 6 h from the time of injury to prevent complications like avascular necrosis of the femoral head. Relevant anatomy, injury mechanism, classification, diagnosis, associated injuries, treatment, and complications have also been discussed.

Introduction: Hip dislocations are extremely rare, but they are orthopedic emergencies that need to be immediately intervened. Traumatic hip dislocations are usually unilateral and occur toward the posterior region. Bilateral traumatic hip dislocations, on the other hand, are rarer. Asymmetric occurrence of bilateral traumatic hip dislocations is even rarer. The possibility of spontaneous hip dislocation in a healthy person is very unlikely. This is because ligaments wrapping the hip joint make it quite stable. Thus, hip dislocation usually occurs due to a high-energy trauma. Case Report: In this paper we report a unique female patient with asymmetric bilateral traumatic hip dislocation accompanied by a segmental fracture of the femur due to a traffic accident. The patient’s right hip was reduced under sedoanalgesia at the emergency department and the left hip was reduced under anesthesia at operating room. Avascular necrosis did not develop at her 2-year follow-up; however, she has been re-operated after developing nonunion in the left femoral segmental fracture. Conclusion: In conclusion, hip dislocations should be treated in first six hours due to the risk of avascular necrosis. Uncomplicated hip dislocations without accompanied fractures can be treated with sedoanalgesia in emergency service settings. However hip dislocations which are complicated with accompanied fractures should be reduced in operation rooms without delay.

Simultaneous asymmetric bilateral traumatic hip dislocation

In cerebral palsy children with bilateral hip dislocation, a new therapeutic concept was established that treated the less affected hip conservatively and the more affected hip simultaneously with an adductor tenotomy. The current study assessed whether the clinical and radiological outcome was equal to that of established bilateral surgical treatments. We also examined whether this approach leads to an adequate motor function improvement of the affected children. In 41 children with cerebral palsy and bilateral hip dislocation, a prospective study assessed the hip abduction, migration percentage (MP) and the motor function (Rancho los Amigos scale). Depending on the pretherapeutic status, all patients were grouped into 3 abduction and 3 MP groups. The less affected hip was treated with a hip abduction splint whereas the more affected hip of the same child was simultaneously treated with a subcutaneous adductor tenotomy. All patients were assessed annually for 4 years. The hip abduction of the conservatively treated hips was pretherapeutically 41.8 +/- 2.6 degrees and improved significantly after 1 year. Patients with a pretherapeutic hip abduction < or = 20 degrees showed the most improvement. After 4 years, a significant deterioration of abduction was avoided in 49%. The pretherapeutic MP of the conservatively treated hips was 31.6 +/- 3.4% and was significantly but only slightly improved. The 4 year MP was significantly improved and the largest improvement was observed when the pretherapeutic MP was larger than 50%. A significant MP improvement after 4 years was achieved in 54%. After 4 years, 34% had undergone a motor function improvement. In 7% a motor function deterioration was observed. Posttherapeutically, the conservatively treated hips showed abduction and MP values that were comparable to those of surgically treated hip joints. In cerebral palsy children with bilateral hip dislocation, the conservative treatment of the less affected hip is suitable to achieve clinical and radiological results that are equal to the surgical treatment of the more affected hip. The concept of a combined conservative and surgical treatment of bilateral hip dislocation leads to an adequate motor function improvement that is comparable to established bilateral treatments.

Staged Bilateral Total Hip Arthroplasty in a Patient With Larsen Syndrome

Bilateral traumatic hip dislocation is rarely seen. A unique case is presented, consisting of bilateral asymmetric hip dislocation with associated segmental fracture femur, resulting from fall from train. This case represents an unusual, severe combination of injuries resulting from the fall from train under influence of alcohol. Traumatic hip dislocation represents a true orthopaedic emergency .Given the severity of associated complications, every effort should be made to ensure prompt diagnosis and immediate therapy. We report our experience in the management of this complex injury pattern and review the pertinent literature on this subject.

Cerebral palsy (CP) often results in severe hip issues, disrupting musculoskeletal development and mobility due to problems such as dislocations and contractures, aggravated by spasticity and heightened muscular tone. While total hip arthroplasty (THA) is required in CP patients, the procedure carries high risks due to concerns about dislocation and wear. This study explores a method of intraoperative navigation to precisely execute preoperative strategies for spinopelvic alignment and optimal cup placement. We discuss a case of a 22-year-old male CP patient with bilateral hip dislocations who experienced significant discomfort, impeding mobility and affecting his performance as a Paralympic rower. He underwent bilateral hip replacement surgeries, guided by preoperative gait analysis and imaging, with navigation aiding in accurate acetabular component placement and correction of excessive femoral anteversion using a modular stem. The patient achieved excellent stability in both standing and rowing postures. Overall, computer navigation enhances complex hip repair by facilitating intraoperative data collection and precise execution of preoperative plans. This approach may extend the lifespan of prostheses,particularly by achieving precise acetabular component placement based on spinopelvic alignment principles, thereby offering significant benefits for CP patients undergoing THA.

Open anterior hip dislocation resulting in vascular injury is extremely rare and is a severe orthopedic emergency that can potentially lead to limb necrosis and even life-threatening consequences. A 51-year-old woman presented to our hospital with an open anterior dislocation of the left hip secondary to a fall from height. The patient had a severe infection in the left inguinal area; at presentation, there was dislocation of the femoral head lasting for the past 5 days. Doppler ultrasound revealed left common femoral vein thrombosis. The patient was diagnosed with a multiple-injury patient with an acetabular fracture, femoral head fracture, and open anterior dislocation of the hip with vascular injury and infection. After placement of an inferior vena cava filter, the reduction was performed under general anesthesia. The common femoral artery ruptured during the process. After suturing, continuous drainage was maintained. During the subsequent treatment, the infection gradually eroded the common femoral artery and formed a pseudoaneurysm. Lower limb vascularity was restored by autologous saphenous vein grafting, repeated debridement, and sensitive antibiotics. The infection of the patient was gradually controlled, and the lower limb was successfully preserved. During the 1-year follow-up, the patient returned to normal life without disability. From this rare case, we suggest that a therapeutic approach should be evaluated after adequate exclusion of deep vein thrombosis to prevent thromboembolic events. Moreover, gentle reduction operation, thorough debridement, and timely infection control are essential to prevent complications and improve the functional prognosis of patients.

We present a case of bilateral hip dislocations with metatropic dysplasia. Radiographic features such as narrow thorax, dense wafer vertebral bodies, narrowing interpedicular distances, kyphoscoliosis, crescent-shaped iliac wings, dumbbell-shaped tubular bones, and inferiorly directing lesser trochanter conform to the findings of metatropic dysplasia. Hip dislocations were misdiagnosed by ultrasonographic and radiographic hip screening, owing to the severely deformed femoral heads and acetabulums. The diagnosis of hip dislocations became possible by magnetic resonance imaging. The bilateral hip dislocation was reduced by open reduction of the hip joints and femoral derotation varus osteotomies.

An 88-year-old man sustained low-energy, bilateral posterior hip dislocation due to a fall, with subsequent right peroneal nerve palsy. Closed reduction was performed in the emergency room, and the hips were found stable to manipulation under anesthesia. To our knowledge, low-energy, bilateral posterior hip dislocation previously has not been described in the literature. Prompt reduction is crucial; however, there is still associated morbidity and mortality, especially in an elderly patient.

Unpredictability of hip behavior in Dyggve-Melchior-Clausen syndrome: A mid-term assessment of siblings

I reported a case of bilateral anterior simultaneous hip dislocation, with small fracture of the posterior superior acetabular edge.When shock not exists, with bilatera dislocation of the hip, both side may be reduced without an interval.Dreaded necrosis of the caput femoris has not followed this instance of simultaneous traumatic dislocation of both hip.This instance not required operative fixation of the acetabular lesion.

In a cross-sectional study of the prevalence of scoliosis in patients with myelomeningocele, 131 patients 5-20 years of age were investigated with clinical examination and radiograms. Sixty-nine percent of the myelomeningocele patients had scoliosis, this prevalence being present already at a young age (6 years). The occurrence of scoliosis increased drastically at high levels of dysraphism, being 20% in patients with sacral myelomeningocele but 94% in patients with thoracic MMC level. Between ages 5 and 10, the mean scoliosis increased successively from 15 to 33 degrees. After this age there was no significant further increase. The ambulatory status of the patients was strongly correlated to the scoliosis incidence. Forty-nine percent of the patients had a uni- or bilateral hip dislocation. There was no correlation between the side of the scoliosis convexity and the side of hip dislocation.

Kabuki syndrome (KS) is a rare syndrome that involves defects in a wide range of organs, with each organ showing a different severity of symptoms. Two genes have been associated with patients with KS: lysine (K)-specific demethylase 6A (KDM6A) and lysine (K)-specific methyltransferase 2D (KMT2D). The study reported the case of an 18-month-old Turkish boy diagnosed with KS. The patient showed a typical appearance: widely separated eyes, sparse eyebrows, long palpebral fissures, blue sclera, large prominent ears, and micrognathia. The patient was operated on because of bilateral hip dislocation and undescended testicles. He was also followed up by pediatric gastroenterology with asymptomatic liver enzyme elevation (AST- 79 U/L, ALT -68 U/L, ALP -52 U/L). The whole exome sequencing analysis revealed a novel pathogenic c.13285 C&gt;T (p.Gln4429Ter) mutation in the KMT2D gene. The genotype-phenotype correlation of KS was not precisely established. As per our knowledge, there is limited literature which gives information about the hepato-biliary manifestations of KS. Here, we propose that the new mutation of the KMT2D gene may result in the typical facial features of KS with asymptomatic elevated liver enzymes.