Low-Energy Bilateral Posterior Hip Dislocation: A Case Report.

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.

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.

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.

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

Although dislocation of the shoulder is a relatively common event, the overwhelming majority of injuries are anterior. Posterior shoulder dislocation is more uncommon, comprising between 3% and 5% of all shoulder dislocations. One percent of shoulder dislocations involve a fracture, whereas only 0.9% of the 1500 cases reported by Neer (J Bone Joint Surg Am 1970; 52:1077-89; J Bone Joint Surg Am 1970; 52:1090-103) concerned posterior fracture dislocations. Bilateral posterior fracture dislocation is an even rarer event, comprising just 5% of all posterior fracture dislocations. Given the rarity and relative poor outcome often observed after these severe injuries, it is important that upper limb function is optimized. Bilateral posterior fracture dislocations of the shoulder pose a difficult clinical challenge that requires careful management planning. To date, there have been three isolated case reports of using contralateral osteochondral humeral autograft and hemiarthroplasty. We report our experiences and clinical outcomes in managing four such cases using a variety and combination of treatments, including the first reported use of reverse shoulder arthroplasty with contralateral osteochondral humeral autografting. Shoulders reconstructed with humeral autograft demonstrated superior Oxford Shoulder Scores and an improved range of motion, as measured by a markerless machine vision system, compared to hemiarthroplasty. Our results support the use of a contralateral humeral autograft in bilateral posterior shoulder fracture dislocation.

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.

Bilateral neglected posterior dislocation of the shoulder treated by reverse arthroplasty and contralateral osteochondral autograft. A case report

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.

Of 2,800 patients admitted to hospital with a diagnosis of seizure, 1.1% (30/2,800) sustained fracture. Of these, 0.5% (15/2,800) had fracture due to direct trauma, 0.3% (7/2,800) had fracture as a consequence of seizure alone, and in 0.3% (8/2,800) the etiology was not determined. In the trauma group, 11 of 17 fractures involved the skull, nasal bones, and clavicle, while in the nontrauma group, the proximal humerus was the site in 6 of 9 fractures. These findings indicate that fracture is an uncommon complication of seizure and is extremely rare in the absence of trauma where, however, the fracture may be pathognomonic (bilateral posterior dislocation or fracture-dislocation of the shoulder) or highly suggestive (unilateral posterior dislocation, fracture-dislocation of the shoulder) of seizure.

Bilateral posterior shoulder dislocations.

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.

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.