A Case Report of Bilateral Asymmetrical Traumatic Hip Dislocation – A Rare Presentation

Abstract

Introduction: Asymmetric bilateral hip dislocations are very rarely reported in literature. We report a unique case of asymmetric traumatic bilateral hip dislocation in a 34-year-old male, describing the management and post-operative complications. Case Report:A 34-year-old truck driver sustained injury to both his hips in a head on collision between two trucks while seated in the passenger seat. There was a delay in presentation at our institution as he was referred after 17 h of the trauma. After evaluation, he underwent closed reduction of both hips under intravenous anesthesia on the same day. The post-reduction assessment revealed a left-sided posterior wall fracture which was suspected due to the instability after reduction. Fixation of the fracture was done using two spring plates. The patient was followed up throughout his rehabilitation and thereafter when he resumed his occupation. Six months after the incident, the patient had pain-free, full range of motion of both hips. Three years after the surgery radiological investigations revealed changes suggestive of early avascular necrosis (AVN), however, the patient did not have any functional restriction. Conclusion: This is a case of bilateral asymmetric hip dislocation with left side posterior wall fracture. It is important to reduce the hip and also address the fracture as early as possible to prevent AVN. Keywords: Bilateral asymmetric hip dislocation, posterior wall fracture, Kocher-Langenbeck, avascular necrosis.

Luxação traumática bilateral assimétrica do quadril: Relato de caso

“…3 As in symmetrical bilateral or unilateral dislocations, they are also associated with a better prognosis when the reduction is performed within 6 hours of the trauma. 2 Regarding outcomes, 61% of patients with asymmetric hip dislocations returned to normal strength, absence of pain and full range of motion (ROM) while 31% evolved with mild pain, small change in ROM or some non-damaging loss of strength. The remainder of patients developed impairment or changes in lifestyle due to long-term complications, generally found in patients with multiple injuries.…”

“…The first reported case of bone exposure was described in 2023 by Santoso et al 8 Associated fractures were reported in 44% of patients, with acetabulum fracture accounting for 75% of these fractures. 2 Negligence in asymmetric hip dislocation is considered when the dislocation time is more than 1 week. 9 The treatment of neglected hip dislocations is complex, due to the formation of fibrous tissues in the joint.…”

“…Conhecida também como “deformidade varrida pelo vento”, luxações assimétricas do quadril são raras em virtude das forças necessárias para gerar uma luxação anterior do quadril serem exatamente opostas àquelas necessárias para reproduzir uma luxação posterior. 2 6 O mecanismo do trauma em luxações posteriores resulta de uma força compressiva axial direcionada ao joelho, enquanto o quadril está em flexão e adução. De maneira oposta, em luxações anteriores do quadril, a força é aplicada com o membro em abdução e rotação externa.…”

“…3 Tal como em luxações bilaterais ou unilaterais simétricas, também estão associadas a melhor prognóstico quando a redução for realizada em até 6 horas do trauma. 2…”

“…O mecanismo de trauma destas lesões geralmente está relacionado à alta cinemática, associado a fraturas acetabulares. 2 São mais comuns em pacientes jovens do sexo masculino. 3 Em comparação ao século passado, a incidência de luxações assimétricas do quadril aumentou consideravelmente em decorrência dos acidentes de trânsito.…”