Iatrogenic Obturator Hip Dislocation with Intrapelvic Migration

Abstract

Obturator hip dislocations are rare, typically resulting from high-energy trauma in native hips. These types of dislocations are treated with closed reduction under sedation. Open reduction and internal fixation may be performed in the presence of associated fractures. Still rarer are obturator hip dislocations that penetrate through the obturator foramen itself. These types of dislocations have only been reported three other times in the literature, all within native hips. To date, there have been no reports of foraminal obturator dislocations after total hip arthroplasty. We report of the first periprosthetic foraminal obturator hip dislocation, which was caused iatrogenically during attempts at closed reduction of a posterior hip dislocation in the setting of a chronic greater trochanter fracture. Altered joint biomechanics stemming from a weak hip abductor mechanism rendered the patient vulnerable to this specific dislocation subtype, which ultimately required open surgical intervention. An early assessment and identification of this dislocation prevented excessive closed reduction maneuvers, which otherwise could have had detrimental consequences including damage to vital intrapelvic structures. This case report raises awareness to this very rare, yet potential complication after total hip arthroplasty.

Traumatic Hip Dislocation Associated with Iatrogenic Proximal Femoral Physeal Fracture in Children: A Systematic Review and Case Report

“…Herrera-Soto et al Also recommend reduction under fluoroscopy so that the epiphysis can be stabilized and any early signs of physeal instability can be found [27]. The patient in our research suffered from an extraordinarily uncommon injury -irreducible trans obturator hip dislocation -that has only ever been documented in adult patients [28,29]. Prior to transfer, he had many reduction efforts at a different location, as well as a closed reduction attempt while under general anesthesia at our facility.…”

Shape analysis and morphometric evaluation of the obturator foramen in dry human bones

“…Morphometric data of OF can guide clinicians in procedures such as transobturator tape placement, obturator nerve blockade, and obturator bypass surgery (7)(8)(9). The femoral head may penetrate the OF in orthopedic conditions such as hip dislocation (13,14). Morphometric evaluation of OF may increase surgical restoration's success in treating such traumatic problems (13,14).…”

“…The femoral head may penetrate the OF in orthopedic conditions such as hip dislocation (13,14). Morphometric evaluation of OF may increase surgical restoration's success in treating such traumatic problems (13,14).…”

Iatrogenic Physeal Separation During Attempted Reduction of an Obturator Hip Dislocation

“…7,13 The patient described in our report had an extremely rare injury (irreducible transobturator hip dislocation), which has previously only been described in adults. [8][9][10][11] He underwent multiple…”

“…The authors were able to find only four other mentions of obturator dislocations where the femoral head had penetrated the foramen, and all four were adult patients. [8][9][10][11] There are no reports of an obturator dislocation with an intrapelvic femoral head in the pediatric population, and no reports of intraoperative acute physeal separation with retained capital femoral epiphysis after reduction of an obturator dislocation.…”