Traumatic Bilateral Anterior 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.

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.

This is a case report of a traumatic bilateral anterior dislocation of the hip in a 27-year-old man. No other cases of bilateral traumatic anterior dislocation seem to have been previously reported in the literature.

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.

Anterior hip dislocations are uncommon, but are associated with the risk of occlusion of major vessels of the limb. We report a case of traumatic anterior hip dislocation who had an on-table cardiac arrest following reduction of hip. It was due to pulmonary embolism, and delayed presentation increased the risk for the same. It was an unanticipated event for us and we wish for all the providers to be aware of this occurrence.

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.

Rationale:Bilateral anterior shoulder dislocation is clinically rare and has been reported to be related to high-speed sports.Patient concerns:A 76-year-old woman presented with bilateral shoulders pain after traditional Chinese manipulation.Diagnoses:She was diagnosed with bilateral anterior dislocations, and a closed reduction was immediately performed.Intervention:The patient was referred for rehabilitation 3 days later, and bilateral rotator cuff injuries were identified from musculoskeletal ultrasound. After 4 weeks of physical therapy, the patient's shoulder pain had reduced and the passive ROM was nearly full.Outcomes:At 1-year follow-up, only mild intermittent shoulder pain was noted, and there was no limitation of shoulder ROM.Lessons:This case illustrates that patients with acute shoulder injuries who receive proper diagnosis and treatment can achieve good outcomes. Therefore, patients with musculoskeletal disorders should seek qualified specialists for accurate diagnosis and appropriate management.

Luxation antérieure bilatérale des épaules

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.

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 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.

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.

Traumatic anterior hip dislocations are subdivided to obturator (inferior) and pubic (superior) dislocations by Epstein's descriptive classification. This rare injury is thought to have favourable clinical outcomes. The incidence of associated femoral head and acetabular injuries has been low in past case series. We sought to revisit this injury and classification in the era of advanced imaging and contemporary surgical techniques. A retrospective study of 15 patients treated for anterior hip dislocation was performed. Medical records were reviewed for demographic and surgical data. Imaging studies were revisited to determine direction of dislocation and associated fractures. Patients were assessed for pain, hip function using the modified Harris Hip Score (mHHS), hip range of motion and radiographic changes. Mean follow-up time was 3 years. Anterior dislocation occurred in an obturator (inferior), pubic (superior) or central direction. 9 patients had concomitant femoral head impaction and 7 patients suffered from acetabular fractures. 8 patients with an anterior hip dislocation underwent surgical treatment. This therapy, along with early range of motion and weight bearing, produced favourable clinical outcomes with 9 patients reporting no pain and an average mHHS of 83.8. 6 patients had heterotopic ossification at latest follow-up. Traumatic anterior hip dislocation is commonly associated with femoral head impaction and acetabular injuries which should be addressed operatively when appropriate to produce favourable results. In this paper, we propose a revision to the commonly used descriptive classification system.