LATE-DIAGNOSED ASYMMETRIC BILATERAL TRAUMATIC HIP DISLOCATION: A CASE REPORT

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.

Asymmetric bilateral traumatic hip dislocation: Report of two cases

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.

Traumatic hip dislocation can be isolated or associated with acetabular fracture. Both injuries require emergency reduction of the dislocated hip. Avascular necrosis of the femoral head (AVN) is a potential complication that accompanies these severe injuries. Our objective is to identify the risk factors that cause AVN. We retrospectively analyzed 44 patients with traumatic hip dislocations (Group A) and patients with posterior fracture-dislocation of the acetabulum (Group B). The average follow-up was 5.38years in Group A, 5.59years in Group B. We used the Thompson-Epstein classification for hip dislocation and the Harris Hip Score (HHS) for evaluating final outcomes. In Group A, we analyzed 21 patients with isolated posterior hip dislocation. We had one (4.76%) case of AVN. In Group B, we analyzed 23 patients with posterior acetabular fracture-dislocation. We had eight (34.78%) patients with AVN (p = 0.016, p < 0.05). With hip reduced 6-12h after injury, we had AVN in one (4.34%) patient, with reduction 12-24h, AVN was present in two (8.69%), while in hip reduction done after 24h of injury, AVN was present in five (21.73%) patients (p = 0.030, p < 0.05). An essential prerequisite for the prevention of AVN of the femoral head after hip dislocation is emergency hip reduction. In acetabular fracture-dislocation, emergency hip reduction, anatomical reduction of the acetabular fracture and early stable osteosynthesis are also important. Main factor affecting the development of AVN is late reduction of the hip.

Simultaneous asymmetric bilateral traumatic hip dislocation

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.

The aim of this study was to evaluate the outcomes of reduction in the treatment of traumatic posterior hip dislocation in children. Data of 22 pediatric patients (22 hips) with traumatic hip dislocation from January 1995 to December 2007 were analyzed. The clinical evaluation focused on symptoms, physical findings, and range of motion. Radiographs identified the type of hip dislocation. The hip dislocation classification was based on Thompson and Epstein. The reduction procedure was performed according to three variants: variant 1, closed reduction; variant 2, release of the adductor longus, lengthening of the psoas tendon, and insertion of a Kirschner wire through the femoral head into the acetabulum; and variant 3, removal of the soft-tissue interposition of the hip. After reduction, radiography was used to determine whether the hip is concentric and to check whether any other injuries might have been caused after manipulation. There were six females (27.3%) and 16 males (72.7%) in this study. All had type I posterior dislocation of the hip. The ages of the patients at diagnosis ranged from 3 years, 2 months to 9 years, 10 months. The reduction procedure was performed according to variant 1 in 16, variant 2 in five, and variant 3 in one. We attained excellent results in eight hips (36.4%), good results in seven hips (31.8%), fair results in four hips (18.2%), and poor results in three hips (13.6%). There was avascular necrosis in three hips (13.6%), coxa magna in two hips (9.1%), deficient limb of 2 cm in two hips (9.1%), and a limp in two hips (9.1%). The hip scores were 82.4 points on average (range 62-100). Children with traumatic hip dislocation should undergo reduction as soon as possible. If the interval from injury to reduction exceeds 3 weeks, we suggest that the surgeon release the adductor longus, lengthen the psoas tendon, and insert a Kirschner wire. This simple and safe surgical procedure results in marked improvement in hip function and prevents complications later.

Background and PurposeAmerican football generates the most sports-related injuries in the United States, with tackling as the leading injury mechanism. Overall injury rate at the collegiate level has been reported as 8.61 per 1,000 athlete exposures (AEs) – twice the rate of high school levels; competition injury rates are reported as high as 36.94/1000 AEs. Traumatic hip dislocation is an uncommon injury typically arising from high-energy axial impact with only 2-5.5% occurring during sports activities.Case DescriptionA 22-year-old NCAA Division I football defensive back who experienced extreme left hip pain following contact with another player with his hip flexed during a game was diagnosed with a type 1 posterior hip dislocation, a grade 1 medial collateral ligament sprain with concomitant posterior thigh and hip muscle strains. Key impairments were limited left lower extremity motor performance, range of motion deficits, left hip pain, and diminished function and weight-bearing ability.OutcomesThe athlete reintegrated into typical defensive back off-season training approximately four to five months post injury without restrictions, however presented with new anterior hip pain seven months post injury revealing occult sequelae requiring surgical intervention. He was able to return to full play the following football season.DiscussionThis case report describes the successful return to sport of a Division I football player who sustained a traumatic posterior hip dislocation and complicated course including surgical intervention secondary to associated sequelae.Level of Evidence5

The objective was to report the ability of a magnetic resonance image to document the integrity of the obturator externus tendon after posterior hip dislocation as a potential predictor for preserved femoral head vascularity. Retrospective radiographic and clinical pilot study. Level I trauma center. Nineteen consecutive patients with traumatic posterior hip dislocation. OUTCOME EVALUATION: Intraoperative correlation of soft tissue damage and radiographic assessment of avascular necrosis of the femoral head 3 years postinjury. Magnetic resonance imaging performed in the acute phase of posterior hip dislocation. Correlation with intraoperative findings during surgical hip dislocation and with avascular necrosis 3 years postinjury. The obturator externus tendon was intact in all cases with preserved femoral head vascularity. After a 3-year follow up, there were no cases of avascular necrosis. In this small series of patients, posterior hip dislocation did not imply a tear of the obturator externus muscle. An intact obturator externus tendon suggests preservation of the deep branch of the medial femoral circumflex artery to the femoral head.

In children, traumatic hip dislocations although rare, but are more common than hip fractures. Trivial injuries may cause a hip dislocation in young children because of their immature pliable cartilage and lax ligament. Subtrochanteric femoral fractures occur below the lesser trochanter to 5 cm distally in the shaft of the femur. In young and healthy individuals, the injury usually results from high-energy trauma. Posterior dislocation of hip with subtrochanteric fracture is very rare and it usually results due to a significant injury. We report a case of nine year old child, presenting with posterior dislocation of hip with ipsilateral subtrochanteric fracture of left femur. Such types of injuries are not fitting into any present system of classifications.

Unusual combination of femoral head dislocation associated acetabular fracture with multipart femoral fractures: Case report

Traumatic hip dislocation results from the dissipation of a large amount of energy about the hip joint. Clinically, these forces often are first transmitted through the knee en route to the hip. It is therefore logical to look for coexistent ipsilateral knee injury in patients with a traumatic hip dislocation. Over a one-year period, we prospectively evaluated the ipsilateral knee of all patients who had a traumatic hip dislocation on the basis of a standardized history, physical examination, and magnetic resonance imaging. Twenty-one (75%) of the twenty-eight knees were painful. Twenty-five (89%) of the twenty-eight knees had visible evidence of soft-tissue injury on inspection. Magnetic resonance imaging revealed evidence of some abnormality in twenty-five (93%) of twenty-seven knees, with effusion (37%), bone bruise (33%), and meniscal tear (30%) being the most common findings. The present study provides evidence of a high rate of associated ipsilateral knee injuries in patients with a traumatic hip dislocation. Bone bruises may provide a plausible explanation for persistent knee pain following a traumatic hip dislocation. The liberal use of magnetic resonance imaging is recommended for the evaluation of these patients in order to detect injuries that may not be discoverable on the basis of a history and physical examination alone.

To the editor, We read the study, “Femoroacetabular Impingement Predisposes to Traumatic Posterior Hip Dislocation” by Steppacher et al. [3] with great interest. As the authors mentioned, the proposal that femoroacetabular impingement could play a role in low-energy hip dislocations was suggested by Philippon et al. [2], based on the arthroscopic findings in professional athletes during active competition. There are scarce references reporting anatomic factors that predispose to posterior hip dislocation [4]. Steppacher and colleagues’ article proposed a mechanism of fulcrum by the interaction between the nonspherical femoral head and the acetabular rim in patients with femoroacetabular impingement-type CAM [3]. We were satisfied to read that the authors agreed with the mechanism that we recently described and represented graphically [1] in a case report of a young soccer player with femoroacetabular impingement that suffered from a low-energy posterior fracture-dislocation. In our publication, we also suggested other factors that could enhance posterior hip dislocation in patients with femoroacetabular impingement: retroversion of the femoral neck, retroversion of the acetabulum, and decreased acetabular depth. The study by Steppacher et al. [3] shows a higher prevalence of femoroacetabular features in patients with posterior hip dislocation compared with the normative data of the proposed mechanism. We believe posterior low-energy hip dislocation should not only be attributed to femoroacetabular impingement as an isolated mechanism. Further investigations should be performed to rule out the contributing factors in this entity.

Traumatic Bilateral Anterior Hip Dislocation: A Case Report

Children, especially those under the age of five, seldom get hip dislocations. Young children may sustain dislocations from minor accidents such as slips or falls from low heights, whereas adolescents typically do so from high-intensity events such as car crashes or collision sports. Posterior dislocation occurs 8-9 times more frequently than those in the anterior. Here, we describe about the acute posterior hip dislocation suffered by a 5-year-old boy in this case report. A 5-year-old girl reported to ER with left hip pain and difficulty to walk after slipping and falling while playing football at home. About 90 min after the fall, she presented at the hospital. The injured hip showed internal rotation, adduction, and flexion. An immediate pelvis X-ray revealed a right hip posterior dislocation. Under intravenous anesthesia, the dislocation was successfully reduced utilizing the Allis technique in the emergency room 3 h after the accident. Post-reduction radiographs verified that the reduction was successful. After 15 days of immobilization and 2 weeks of bilateral skin traction, the youngster was able to resume full weight-bearing walking with excellent tolerance. To reduce the risk of avascular necrosis (AVN), pediatric hip dislocations require prompt reduction within 6 h. Soft-tissue injuries are found using post-reduction magnetic resource imaging. AVN requires constant observation for at least 2 years. Since traumatic hip dislocations in children under the age of five are rare, prompt diagnosis and treatment are essential.