Traumatic anterior dislocation of the hip associated with ipsilateral femoral shaft fracture in a child: a case report

Concurrent ipsilateral fractures of acetabular posterior wall and femoral shaft associated with posterior hip dislocation: A case report and literature review of a rare injury

INTRODUCTION

A floating hip injury involving the acetabulum and femur, often complicated by hip dislocation, necessitates a timely and appropriate management strategy to preserve the extremity and patient well-being.

CASE PRESENTATION

We present a case of a 20-year-old male with concurrent fractures of the acetabular posterior wall, a comminuted femoral shaft, and posterior hip dislocation. Reduction of the dislocated hip posed a challenge due to the femoral shaft fracture. We successfully employed an innovative technique, using pins proximal and distal to the shaft fracture in conjunction with a temporary external fixator, later replaced by an interlocking nail after hip reduction. Subsequently, we addressed the acetabular fracture through a posterior hip approach, enabling the patient to regain full weight-bearing capacity within a few months.

DISCUSSION

In managing concurrent injuries in a floating hip, particularly when a femoral shaft fracture is involved, innovative approaches, such as the one described in this study, are crucial for timely hip reduction. Following hip reduction, a series of surgeries are required to address the multiple lower extremity injuries, prioritizing those with the highest risk of adverse events and neurovascular complications.

CONCLUSION

Urgent procedures for multiple fractures in orthopedic trauma surgery are pivotal for the best long-term outcomes. Prioritizing these urgent procedures, even through unconventional transient methods when conventional means are unavailable, can prevent long-term complications such as avascular necrosis. Effective and timely management is paramount for optimal patient recovery.

Prognostic and therapeutic interest of a new classification in inferior hip dislocation: a systematic review of the literature

INTRODUCTION

Reported cases of inferior dislocation in the literature are found under several names (inferior, anteroinferior, obturator, or erecta), which may be source of confusion. The purpose of this comprehensive review of the literature is to collect as many cases of inferior dislocation as possible to determine better therapeutic strategies, outcome after reduction, complications, and prognostic factors.

METHODS

In April 2020, a literature search was performed in Pubmed, Medline, Scopus, Cochrane, and Embase databases. The MeSH keywords were "OBTURATOR DISLOCATION HIP" or "ANTERIOR DISLOCATION HIP" or "INFERIOR DISLOCATION HIP." Authors independently selected articles that met the selection criteria, with no time limit.

RESULTS

Out of the 97 articles selected, there were 119 cases of primary inferior hip dislocations. This review of the literature has allowed us to differentiate 3 radiographic subtypes of inferior dislocations, which correspond to 3 different anatomical positions of the femoral head: "obturator" dislocation, "proximal anterior-inferior" dislocation, and "distal anterior-inferior" dislocation. Our subtype classification yielded 39 obturator subtype inferior dislocations (32.8%), 66 proximal anteroinferior subtypes (55.4%), and 14 distal anteroinferior (11.8%). The obturator subtype is at risk of reduction failure and femoral neck fracture during the reduction manoeuver.

CONCLUSIONS

Our study identified 3 subtypes with different prognosis, with obturator and distal anteroinferior dislocations having a poorer prognosis because of their pre- and post-reduction complications. We were unable to determine the correct manoeuver to reduce inferior dislocations without taking the risk of femoral neck fracture, but each of these subtypes may require a different manoeuver.

Traumatic Obturator Dislocation of the Hip Joint Associated with Greater Trochanter Fracture: A Case Report

Background

Traumatic obturator dislocation of the hip joint associated with greater trochanter fracture is a rare injury. We used the lateral approach through the rectus abdominis to remove the femoral head dislocated into the obturator, and the posterolateral approach was used for reduction and internal fixation of the femoral greater trochanteric fracture and total hip replacement (THR). Good follow‐up results were achieved. To the best of our knowledge, this is the first report on this particular type of injury and on this approach to treating this type of injury.

Case Report

The patient was hospitalized due to a traffic accident that resulted in the patient experiencing swelling and deformity accompanied by limited mobility of the left hip and left knee.

X‐ray examination and CT confirmed that the patient suffered from left hip obturator dislocation, greater trochanter fracture, pelvic fracture (Tile B), left acetabular fracture, right open tibiofibular comminuted fracture (Gustilo III), and posterior urethral injury.

The femoral head was removed from the pelvic cavity through a pararectus approach under general anesthesia. A posterolateral approach was used for open reduction, and cable internal fixation for the left intertrochanteric fracture and uncemented THR were performed.

Results

The ability to work was restored 6 months after the operation. The Harris hip score, reflecting joint function, was 86 points after 2 years of follow‐up observation.

Conclusion

A lateral approach of rectus abdominis to remove the dislocated femoral head in the pelvis from the obturator should be selected, along with the posterolateral approach for reduction and internal fixation of the intertrochanteric fracture and THR. This case also provides a new reference for the treatment of this type of hip fracture dislocation.

Ipsilateral open anterior hip dislocation and avulsion fracture of the greater trochanter: An unusual case report

Approximately 3% of all joint dislocations involve the hip joint, and only 8-10% of these will be anterior. Traumatic anterior open dislocation of the hip is rare in children and prone to be associated with injuries, extensive soft tissue damage, and avascular necrosis of the femoral head. We present a case of a 13-year-old boy who had an open anterior dislocation of the hip with ipsilateral avulsion of the greater trochanter after a tractor wheel crush in an agricultural accident. Additional lesions included a diaphyseal closed fracture of the contralateral femur. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management.

Revascularization of the necrotic femoral head after traumatic open anterior hip dislocation in a child: a case report

INTRODUCTION

Avascular necrosis of the femoral capital epiphysis is the most serious complication after traumatic dislocation of the hip in children. This case report discusses the localization and revascularization of the necrotic femoral head following rarely experienced traumatic open anterior hip dislocation in children.

CASE PRESENTATION

Our patient was an 11-year-old Japanese boy who had open anterior hip dislocation sustained in a traffic accident. Reduction of the hip joint was performed in an emergency operation, and he was evaluated using serial gadolinium-enhanced magnetic resonance imaging. T1-weighted magnetic resonance images showed two bands with low signal intensity in the femoral capital epiphysis on coronal and oblique axial planes, indicating the existence of avascular osteonecrosis of the femoral head. We observed gadolinium enhancement in the central region of the epiphysis, where the area between the two bands with low signal intensity was located. Serial assessment with enhanced magnetic resonance images during a non-weight-bearing period of 1.5 years after injury showed revascularization starting from the central region and converging toward the peripheral region. Although the patient had leg-length discrepancy due to the early epiphyseal closure, non-weight-bearing treatment for the avascular osteonecrosis of the femoral head achieved a favorable outcome without any hip joint dysfunction, pain, or sign of secondary osteoarthritic change within 4.5 years after injury.

CONCLUSION

We confirmed the revascularization process of the necrotic lesion in the femoral capital epiphysis in an 11-year-old boy using serial gadolinium-enhanced magnetic resonance imaging. Conservative non-weight-bearing treatment achieved a favorable outcome.

Traumatic anterior hip dislocation with associated bilateral femoral fractures in a child: a case report and review of the literature

Traumatic anterior hip dislocation is rare, because the hip joint is a highly stable joint. It is extremely rare for the anterior hip dislocation with combined bilateral femoral fracture in children. We present a case of 7-year-old boy with traumatic anterior hip dislocation with associated bilateral femoral fractures. Radiographic examination showed the right femoral head was dislocated anteroinferiorly. The ipsilateral femoral shaft showed a transverse femoral shaft fracture and proximal and distal femoral bifocal fractures of the contralateral femur. The dislocation of the right hip was reduced 10 hours after the injury in local hospital. One week later, the right femoral shaft fracture and left proximal femoral fracture were open reduced and internally fixed with plate and screws and the distal left femoral fracture was closed reduced and fixed with Kirschner wires. Postoperatively, active hip flexion and extension to recover hip and knee movement were then permitted but without weight bearing for 3 months. Radiographs at 3 months, at 6 months showed the fractures healed well and hardware were removed respectively. However, irregularities of the femoral head meaned avascular necrosis of the femoral head. This case stresses the importance of a rapid evaluation and treatment for the dislocation of the hip, providing a stable reduction and a firm internal fixation of the associated fractures.

Update review and clinical presentation in adult inferior dislocation of hip

Inferior dislocation of the hip is a rare clinical entity, wherein closed reduction maneuver could be challenging, especially if the attending surgeon is not familiar with the specific anatomy associated with this injury. Due to the rarity of this type of injury, large case series are lacking in the literature; hence, case reports form the major source of our knowledge regarding the clinical presentation and management. An extensive literature search revealed a change in age group presenting with this specific injury, with a male predilection. They were frequently cited in the pediatric age group of less than 16 years in the last century. Recently, the cases have been documented in adults. An up-to-date review of the current literature on the mechanism of injury, clinical presentation, management, outcomes and complications of inferior dislocation of hip has been highlighted in this article. In addition, we share our experience with three such dislocations presenting in adult males with an age range of 38-62 years.

Ipsilateral obturator type of hip dislocation with fracture shaft femur in a child: a case report and literature review

The incidence of traumatic hip dislocations in children is rising in this fast developing world along with increasing numbers of high-velocity road traffic accidents. Anterior dislocation of the hip has a lower incidence compared with posterior dislocation of the hip. We encountered a rare case of the obturator type of anteriorly dislocated hip associated with ipsilateral fracture of the shaft femur in an 11-year-old child. This is a highly unusual injury combination and the mechanism of injury is obscure. Only two similar cases have been reported in the English literature to date. Closed reduction of the hip using a hitherto undescribed technique and an intramedullary interlocking nail was performed in this case. At 6 months of follow-up, the fracture shaft femur has united and the child is bearing full weight on the limb.

Emergency department diagnosis and treatment of traumatic hip dislocations in children under the age of 7 years: a 10-year review

BACKGROUND AND AIMS

Traumatic hip dislocations (THD) are uncommon in children. They constitute true emergencies because unrecognised THD leads to avascular necrosis (AVN) of the femoral head. This review presents the evidence for best practice for the diagnosis and treatment of THD in the emergency department (ED) of children under the age of 7 years.

METHODS

Searches for the period 2002-2012 were performed in PubMED, Cochrane database, EMBASE, Google Scholar and hand search.

RESULTS

Twenty-five case reports and case series articles were identified, 53 described children with acute and 23 with neglected THD. Overall, 42 (55%) were male and 73 (96%) sustained a posterior dislocation. Forty-eight (63%) had THD following a low-energy trauma. Eight (11%) reported associated injuries. Twenty-one (39.6%) acute dislocations were reduced in the ED without complications. AVN was identified in 3 (5.7%) children, who underwent reduction ≥10 h after dislocation. Redislocation occurred in 3 (5.7%) children and coxa magna developed in 5 (9.4%). Long-term functional outcome of 42 patients resulted in full recovery, and it was fair to good in 3 (including 2 children with AVN). All neglected cases (≥4 weeks from trauma) needed open reduction in the operating room (OR). AVN was identified in 11 children (47.8%). Hip function was completely recovered in 16 (70%) patients.

CONCLUSIONS

THD in this age group mainly occurs with low-energy trauma and leads to posterior dislocations. Urgent closed reduction of acute cases are done in the OR, or the ED. ED reduction appears to be safe. Neglected THDs need open reduction.

Traumatic anterior dislocation of hip in a teenager: an open unusual type

Traumatic anterior open dislocation of hip is rare in children and prone to be associated with injuries, extensive soft tissue damage and avascular necrosis of the femoral head. We report a hitherto undescribed anterior open dislocation of the hip joint in a 14-year-old boy. The dislocated head finished up in the contralateral obturator foramen. The management of the case and its relation to published classifications of anterior hip dislocations in children are discussed.

Traumatic hip dislocation in a 3-year-old girl

Traumatic hip dislocation in the pediatric patient requires much less energy than in an adult, yet it remains a rare diagnosis. We report the case of a 3-year-old girl who dislocated her right hip when bindings failed to release as she skied downhill. The hip was promptly reduced in the nearest trauma center, and at 18 months after injury, there is no evidence of avascular necrosis. The potential risk of avascular necrosis is significant, and the risk rises greatly when reduction is delayed beyond 6 hours. Reduction can be safely performed in the emergency department, although up to 25% of cases will require open reduction in the operating room. A high index of suspicion is warranted to not miss the "golden window" and achieve satisfactory reduction in a timely fashion.