Traumatic hip dislocation with spontaneous incomplete reduction: a diagnostic trap

We are reporting three children and adolescents who presented with incongruous reduction of the hip following injury. In each case, the diagnosis was initially missed. None of the patients presented with a hip dislocation, but two gave a history consistent with transient hip subluxation or dislocation. Low-energy trauma was the cause in two cases. Treatment consisted of arthrotomy to remove interposed capsule and labrum to obtain concentric reduction. When reduction of a hip dislocation occurs spontaneously, the condition may be misjudged. Any child or adolescent who complains of hip pain following injury should have radiographs scrutinized for asymmetric widening of the hip joints. Any asymmetry should be evaluated by appropriate imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). Removal of any interposed tissue is recommended, even when the diagnosis is delayed by several months.     

Traumatic hip dislocation complicated by soft tissue interposition--a case report and review of the literature]

Traumatic hip dislocation is by far less common in children than in adults. It occurs 4 times more frequently in boys than in girls. The force of the trauma leading to hip dislocation can be surprisingly small. Incomplete reduction is mainly caused by soft-tissue interposition or fragments of cartilage from the acetabulum. In such cases an X-ray examination will reveal a lateral protrusion of the femoral head. CT scans and MRI investigation play an important role in further diagnostics of the patient. The paper presents the case of a 5 year old boy with traumatic hip dislocation complicated by soft-tissue interposition. After an unsuccessful attempt of closed reduction, the hip was reduced surgically. The interposing element was removed--part of the cartilagenous insertion (size: 3 x 3 mm) of the femoral head ligament. During a follow-up examination 10 months post-op no signs of necrosis nor loss of ROM were noted.     

Ipsilateral anterior then irreducible posterior hip dislocation without fracture: a case report

Anterior hip dislocations and posterior hip dislocations are injuries that commonly result from high-energy trauma. Different mechanisms of injury and forces are typically required for anterior and posterior hip dislocations. We present the case of a patient who sustained an injury that initially resulted in an anterior hip dislocation. After reduction and without experiencing further significant trauma, the patient dislocated posteriorly while being transferred from a stretcher to a table in radiology some 14 hours later. To our knowledge, there have been no such presentations in the literature.     

Traumatic hip dislocation in the paediatric population: A case series from a specialist centre

IntroductionTraumatic hip dislocation is a rare injury in the paediatric population. It can occur after high energy trauma, but also after lower energy injuries especially in younger children. Posterior dislocation is the most common pattern of hip dislocation. In most cases, closed reduction is successful, but occasionally open reduction is required to achieve concentric reduction. The aim of our study was to present the 10-year experience from a Level-1 Trauma Paediatric Hospital and to comment on how our experience correlates with the current literature.Patients and methodsThis is a retrospective case series of all paediatric patients (< 16 years old) with a traumatic hip dislocation presented and/or treated at our institution, between the 1^st of January 2010 and 31^st August 2020.ResultsThirteen cases of traumatic hip dislocation were identified. There were 7 females. The mean age was 9.8 years. Typically, younger patients were involved in lower energy injuries. The direction of hip dislocation was posterior in ten cases. Associated injuries were seen in eight patients. All cases underwent closed reduction, which was successful in nine cases. Mean time to reduction was 6.8 hours. Post reduction imaging with CT and/or MRI was performed in all cases. There was residual subluxation in three cases, requiring open reduction. In one case with unrecognised undisplaced physeal injury, closed reduction resulted in a Delbet type 1 hip fracture. Two cases developed avascular necrosis (AVN).ConclusionsTraumatic paediatric hip dislocation is a rare injury. A target of 6 hours for reduction should be employed as this will reduce the risk of AVN in those who have not permanently damaged the vessels at the time of injury. We advocate all attempts for closed reduction to be performed in an operating theatre with the use of an image intensifier to help identifying associated injuries and confirm concentric reduction. If closed reduction fails, open reduction is required. Post-reduction MRI is an important adjunct to recognise associated soft tissue injuries. Follow up of patients should continue for 2 years as a minimum to help detect AVN.     

Recurrent traumatic hip dislocation in a child

Recurrent traumatic hip dislocation is rarely seen in childhood. We presented a case of traumatic hip dislocation which was treated by conservative methods. A two-year-old girl was treated with closed reduction and a hip spica cast for posterior traumatic dislocation in the right hip. Two years later, a recurrent dislocation occurred following a minor trauma on the same side. She was again treated with closed reduction and immobilization with a hip spica cast for three weeks followed by a three-week load bearing restriction. Early follow-up examinations showed an increased internal rotation of the hip compared to the left side, suggesting increased posterior capsular laxity. It then disappeared on her final follow-up at age six and magnetic resonance imaging showed no evidence for avascular necrosis or capsular laxity. She was asymptomatic and her physical examination was within normal limits. Of note, several members in her family had developmental dysplasia of the hip.     

Obturator hip dislocation with intrapelvic migration of the femoral head in Ehlers–Danlos syndrome

Hypermobility of the joints is a cardinal feature of Ehlers-Danlos syndrome (EDS) and joint dislocation as a result of no or minor trauma, is a relatively frequent complication of any form, because of ligamentous laxity [1-3]. Hip dislocations are usually the result of high-energy trauma in young adults, with most being posterior [4-6]. Obturator hip dislocations are relatively rare injuries, accounting for no more than 7% of all traumatic hip dislocations [6, 7]. No obturator hip dislocation as a result of minor insult in EDS has yet been reported. We report an unusual case of obturator hip dislocation by minor insult in EDS, complicated by femoral neck fracture and intrapelvic migration of the femoral head occurring during closed reduction, and also suggest management relevant to this rare injury.     

Ipsilateral femoral fracture and anterior hip dislocation in a 15-year-old girl: case report

Operative management of concomitant ipsilateral femur fracture and anterior hip dislocation has not been previously described in the literature. We report the case of a 15-years-old girl who was injured in a motorcycle accident and presented with a femoral shaft fracture and a concomitant ipsilateral anterior hip dislocation. Operative management consisted of an attempted closed reduction of the femoral fracture, which was unsuccessful; thus, an external fixator was temporarily applied. Subsequently, the hip dislocation was treated by open reduction through an anterolateral approach. Finally, the femoral fracture was securely stabilized using an unreamed femoral intramedullary nail. The postoperative course was uneventful. MRI follow-up after 6 weeks did not reveal any sign of mangled vascularization of the femoral head and radiographs demonstrated normal bony healing of the shaft fracture. Due to the fact that there is no definitive surgical strategy for this rare combination of injuries, concomitant ipsilateral femoral fracture and anterior hip dislocation is an interesting and challenging situation for the trauma surgeon which requires a subtle and exact surgical technique in order to achieve satisfying results.     

A case of pathological fracture caused by vitamin D insufficiency in a young athlete and a review of the literature

Our patient is a 16-year-old boy basketballer with no significant medical history or previous injuries. He fell on his right hip during jogging and sustained a right superior-posterior hip dislocation with a Pipkin type 2 fracture of the femoral head. Manipulation and reduction under sedation then general anaesthesia was unsuccessful he underwent open reduction and internal fixation.Because his fall was of low energy, an endocrinologist was consulted to rule out primary contributing factors to his fracture dislocation. He was found to have insufficient levels of vitamin D (22.4 μg/l) which was replaced subsequently. Other hormonal investigations were unremarkable. The Bone Mineral Density of his left femoral neck measured 1.098, corresponding to a Z-score of 1.1 (normal). At 2 months post operation, our patient was pain free and able to ambulate without aid. Follow up Xrays showed satisfactory alignment with no evidence of osteonecrosis.We conducted a literature search on pubmed with keywords: Hip, dislocation, fracture, minimal trauma, atraumatic, vitamin D deficiency. We then excluded post-operative dislocations and found 4 articles reporting minimal or atraumatic hip dislocations.Posterior hip dislocations have been reported in literature to be a high energy trauma, usually due to an axial load on the femur, typically with hip flexed and adducted. Complex posterior fracture-dislocation of the native hip joint in adults is usually caused by road traffic accidents or falls from heights.Native hip dislocations in adults associated with minimal or no trauma are rarely reported in literature, and are mostly due to hip dysplasia, arthritis, connective tissue disorders or spastic muscular paralysis. Of note there are no reports of vitamin D deficiency causing a hip fracture dislocation.This is the first known case of an athlete sustaining a vitamin D insufficiency fracture. In patients presenting with posterior hip dislocations after minimal or no trauma, underlying causes must be excluded. More research is necessary to investigate the relationship between vitamin D insufficiency and hip dislocations.     

Successful open reduction of a 5-month-old hip dislocation associated with a femoral head fracture

The long-term prognosis after open reduction of neglected posterior hip dislocations is poor; as such, primary arthroplasty is recommended by a number of authors. We present a patient with a 5-month-old posterior hip dislocation with concomitant paralysis of the sciatic nerve who had an open reduction. At a follow-up of 3.5 years, the patient has normal function with no signs of arthrosis. Magnetic resonance imaging scans, however, revealed partial avascular necrosis of the femoral head. A discussion based on the literature shows the uniqueness of this case.     

Simultaneous ipsilateral posterior knee and hip dislocations: case report, including a technique for closed reduction of the hip

In isolation, dislocations of the hip and knee require emergent reduction to minimize the risks of serious complications, including vascular and neurologic injury, osteonecrosis of the femoral head, and loss of motion and function. With simultaneous dislocation of the ipsilateral hip and knee, as in the situation of hip dislocation with concomitant femoral shaft fracture, reduction of the hip may prove difficult because of the inability to control the femoral segment. In this setting, general anesthesia is commonly required. We present the case of a patient who sustained an ipsilateral hip and knee dislocation who underwent closed reduction of the knee in the emergency department but required general anesthesia and the insertion of Schanz pins in the femur to reduce the hip dislocation.     

Unreduced anterior dislocation of the hip in a child

A case of unreduced anterior hip dislocation from trauma is reported, and the literature is reviewed. This is the fourth such case reported in a child.     

Simultaneous anterior and posterior traumatic dislocation of the hip

The presence of anterior dislocation of the hip along with contralateral posterior dislocation of the hip in the absence of other major trauma is a distinctly rare injury pattern. We report such a case resulting from a motor vehicle striking a pedestrian, along with a review of previous cases. The patient was managed nonoperatively within 6 hours of trauma with an excellent final outcome and no posttraumatic complications over a 3-year follow-up. The possible mechanism of this injury is discussed. Received: 23 February 1998     

Traumatic anterior dislocation of the hip joint with posterior acetabular wall fracture

The incidence of traumatic hip dislocation has increased in recent years as a result of high-energy trauma. Anterior hip dislocation forms less than 10-15% of all traumatic hip dislocations. Only a few case reports describe anterior dislocation along with acetabular fractures. The acetabular fracture involved the anterior wall or column in all such cases. We describe a rare case in which anterior superior dislocation of the hip was associated with a large fracture fragment of theposterior acetabular rim and adjacent wall.     

Open anterior-inferior hip dislocation

Traumatic hip dislocations result from high-energy trauma. These dislocations are usually posterior in direction and have severe associated injuries. The less common anterior dislocation is usually of the inferior type. We report a case of an open anterior-inferior hip dislocation secondary to a high-speed motor vehicle collision. The wound was in the medial upper ipsilateral thigh. To our knowledge, this is the first reported case of an adult with an open inferior-type anterior hip dislocation.     

Open anterior dislocation of the hip in child of 7-years-old: A case report and literature review

Traumatic hip dislocation is a rare injury in children, and an open dislocation is exceptional. We report the case of a 7 year old patient who presented an open anterior dislocation of the left hip following trauma by accident of the public highway. The patient received treatment under general anesthesia: articular toilet, debridement and reduction. Then, He was put under traction for 6 weeks and antibiotic. The short term evolution is marked by the occurrence of post-traumatic septic arthritis and osteonecrosis of the femoral head after two months.     

Posterior dislocation of the hip with ipsilateral displaced femoral neck fracture

Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or preserving the femoral head. We presented a case of young adult with such an injury. He was operated upon with reduction of the dislocation and fixation of femoral neck fracture with the help of cancellous screws. Two years later, the fracture had united and the patient was asymptomatic. We further proposed the mechanism of injury for such a fracture and discussed the management in the changing trauma scenario of the developing world.     

Bilateral traumatic dislocation of the hip: simultaneously one hip anterior and the other posterior

The case of a 28-year-old man with bilateral dislocation of the hip, simultaneously one hip anteriorly and the other posteriorly is reported. In this case a very drunk driver without a seatbelt crashed his car. Uncontrolled trauma resulted in two different types of hip dislocation. At the 2-year follow-up he had a serious mobilisation problem with avascular necrosis of one hip. Received: 10 February 1997     

Atraumatic posterior dislocation of the native hip: an unusual presentation of septic arthritis

We present a case of chronic posterior hip dislocation after severe joint destruction following septic arthritis. In the absence of trauma, infection must be considered in the differential diagnosis of a dislocated joint particularly in patients with risk factors such as intravenous drug abuse and immune compromise. Excision arthroplasty of the hip was performed with good pain relief and functional outcomes. This is an excellent temporary or permanent solution in managing such complex cases although alternative management options are discussed.     

Acute limb ischemia following closed reduction of a hip arthroplasty dislocation

Hip dislocation is a well-described complication of total hip arthroplasty (THA) and dislocation rates are substantially higher following revision hip arthroplasty. Vascular complications following closed reduction of hip dislocations are exceedingly rare, but a high index of suspicion is essential for patients with underlying vascular abnormalities. Popliteal artery aneurysms are the most common peripheral arterial aneurysms with a prevalence of 1% and they should be suspected in patients with prominent popliteal pulses. This article presents a case of an 84-year-old man with a revision total THA who sustained a posterior hip dislocation. The hip was reduced under conscious sedation using the Bigelow technique. The leg was distally neurovascularly intact based on the clinical exam immediately before and after the reduction. Over the next few hours, the foot became progressively ischemic and an urgent computed tomography angiogram revealed bilateral popliteal artery aneurysms with acute thrombosis of the aneurysm on the affected limb. The patient underwent emergent femoral popliteal bypass using a Dacron supported interpositional graft. The majority of the foot was salvaged but the toes eventually became necrotic. Direct compression of the aneurysm during reduction of the hip dislocation in conjunction with transiently decreased blood pressure from conscious sedation likely resulted in a low flow state within the artery leading to thrombosis of the aneurysm. To our knowledge, this is the first reported case of such an event. This case emphasizes the need for a high index of suspicion for vascular injuries following manipulation of limbs with underlying arterial aneurysms. Reduction maneuvers for hip dislocations should be modified to minimize compression of the popliteal fossa in limbs with vascular abnormalities. Serial postreduction neurovascular exams are essential for identification and prompt management of vascular complications.     

Herniated intervertebral disc associated with a lumbar spine dislocation as a cause of Cauda Equina syndrome: a case report

To report a case of Cauda Equina syndrome with the completion of the paralysis after the reduction of a L4L5 dislocation due to a herniated disc. Although several articles have described a post-traumatic disc herniation in the cervical spinal canal, this is not well known in the lumbar region. A 30-year-old man was admitted to the emergency room with blunt trauma to the chest and abdomen with multiple contusions plus a dislocation of L4-L5 with an incomplete neurological injury. After an emergency open reduction and instrumentation of the dislocation, the patient developed a complete cauda equina syndrome that has resulted from an additional compression of the dural sac by a herniated disc. In a dislocation of the lumbar spine, MRI study is mandatory to check the state of the spinal canal prior to surgical reduction. A posterior approach is sufficient for reduction of the vertebral displacement, however an intra-canal exploration for bony or disc material should be systematically done.