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

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.

Obturator dislocations of the hip associated with pelvic ring injuries: Case report and review of the literature

Case

An obturator hip dislocation with an associated open book pelvic ring injury is an extremely rare injury pattern. This case report will discuss challenges to closed reduction, acute management strategies and review the literature on combined hip dislocations and open book pelvic ring injuries.

Conclusion

This injury pattern presents unique reduction challenges that should be recognized early in order to provide effective resuscitation and preserve the femoral head blood supply. Failing to close reduce the hip delays reducing the pelvic ring volume because sheets and binders are precluded from working effectively.

Traumatic Hip Dislocation Associated with Proximal Femoral Physeal Fractures in Children: A Systematic Review

Traumatic hip dislocation might lead to serious complications and a poor outcome. Fortunately, it is a rare condition in pediatric patients. The purpose of this study is to establish and describe the complications caused by hip dislocations associated with transphyseal femoral neck fractures. Therefore, we conducted a literature review that resulted in 11 articles, including 32 patients, older than 10 years of age, suffering from traumatic hip dislocation associated with a transphyseal femoral neck fracture. We presented a case series of three patients with hip fracture-dislocation treated in our clinic that were also evaluated and included in the study. For the 35 patients included in the study group, the percentage of avascular osteonecrosis after hip fracture-dislocation was 88.57%. Traumatic hip dislocation associated with transphyseal femoral neck fracture is a rare condition and has a poor prognosis because of the high incidence of femoral head avascular necrosis (AVN). Reduction should be attempted within six hours the from injury, but this may not minimize the risk of AVN if transphyseal separation occurs. The approach may influence the development of AVN; lateral approach of the hip with great trochanter osteotomy seems to have the lowest number of cases of AVN.

Surgical treatment of a traumatic open anterior hip dislocation in a child: A case report and review of 13 cases in the literature

Due to the high probability of infection and avascular necrosis, traumatic open anterior hip dislocation poses a serious orthopedic emergency. Despite the emergency of the issue, it appears to be an under-researched topic in the literature. In this study, we present open anterior hip dislocation with both trochanteric fractures in a child and review other pediatric cases from the literature. Because of rareness, there is no standard surgical and postoperative treatment algorithm. We discussed the mechanism of injury, wound size, time of the reduction, associated injury, type of treatment, type of immobilization, clinical and functional results to present a collective perspective on the literature. Once we have compared all of these situations, dealing with infection is key to satisfactory clinical and functional outcomes. The early reduction was the most important point in both coping with infection and preserving avascular necrosis of the femoral head.

Open Obturator Hip Dislocation: A Case Report and Review of the Literature

CASE

An open obturator dislocation with associated pelvic ring injury and perineal wound underwent fixation and aggressive debridement. Despite this, the patient proceeded to infection requiring additional debridements and prolonged intravenous antibiotics. At 18 months postinjury, the patient developed avascular necrosis and significant heterotopic ossification; however, she was able to ambulate.

CONCLUSIONS

Open obturator dislocations of the hip require a multidisciplinary team. Despite prompt antibiotic therapy and aggressive debridement, patients are at high risk of infection because of the microbial environment in this region. Open obturator hip dislocations are at significant risk of avascular necrosis despite timely reduction.

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.