Inferior hip dislocation after falling from height: A case report

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: About 2 cases and review of the literature

Introduction

Traumatic dislocation of the hip is a serious lesion, and its obturator variety is rarely reported. It always reflects a high-energy trauma and represents a therapeutic emergency that requires a reduction in less than 6 h due to the risk of aseptic necrosis of the femoral head in the long term.

Case report

We reported 2 cases of hip obturator dislocation in patients aged 21 and 45 years respectively, which occurred following a road accident, received for pain and functional impairment of the hip, and in a typical attitude with hip flexion, abduction, rotation and knee flexion with no downstream limb vascular-nervous injury. The emergency reduction in <6 h, in two cases, followed by functional treatment by offloading for 8 weeks and support of the limb with the resumption of walking had been authorized at 3 months with a return to sport at 16 weeks; made it possible to obtain satisfactory results at 18 months of follow-up, with an absence of a functional gene, stiffness and without signs of necrosis of the femoral head.

Discussion and conclusion

Traumatic obturator dislocation of the hip constitutes serious lesions and requires early and appropriate management, reduced to closed focus, treated functionally give excellent results in the medium term. The patient must be carefully monitored over the long term and be warned of the risks he runs.

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Traumatic obturator hip dislocation is a serious lesion and rarely reported.

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Therapeutic emergency requires a reduction < 6 h because the long-term prognosis of the femoral head is strongly linked.

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Simple unloading of the limb without transosseous traction provides excellent medium-term outcomes.

Old unreduced obturator dislocation of the hip: A case report

BACKGROUND

Obturator dislocation is a rare type of hip dislocation, accounting for about 2%-5% of all hip dislocations. The occurrence of old unreduced obturator dislocation is even more infrequent, with only 17 cases reported in nine studies, most of which were from the 1950s to 1980s in developing countries.

CASE SUMMARY

A 38-year-old woman from Hunan Province, China presented with stiffness of the left hip in abduction, flexion, and external rotation after falling from a 2-meter-tall tree onto her left knee 1.5 mo prior. Pelvic radiograph and computed tomography revealed obturator dislocation of the left hip accompanied by impaction fracture at the superolateral aspect of the left femoral head without associated acetabulum fracture. Open reduction was performed, resulting in restoration of the concentric alignment of the left hip. After surgery, 6-wk skin traction was applied and the patient was kept in bed for an additional 2 wk. At 3 mo after surgery, the patient reported experiencing some pain, which did not affect the function of the affected limb, and some movement restriction but no abduction deformity or claudication was present. An X-ray showed that the left hip was homocentric, and there was no sign of posttraumatic arthritis or avascular necrosis.

CONCLUSION

Open reduction may be an effective treatment strategy for the rare condition of old unreduced obturator dislocation with short neglect time.

Anterior Inferior Hip Dislocation: Report of Three Cases and Review of Literature

Introduction:

Inferior dislocation of the hip, also called luxatio erecta femoris, is the rarest type of hip dislocation with a poorly understood mechanism of injury. We came across three such cases resulting from high-energy trauma with various other associated injuries.

Case Report:

The first patient, a 25-year-old man, presented with the right hip pain, hip and knee joint in flexion without rotational component, after motor vehicle collision. The second patient, a 42-year-old man, presented with the left hip pain, hip and knee joint in flexion with rotational component, following fall from 20 ft height. The third patient, a 29-year-old lady, presented with the left hip pain, hip and knee joint in flexion with rotational component, after motor vehicle collision. All three patients were diagnosed by radiograph and were managed by closed reduction under short general anesthesia, within 3 h, 9 h, and 6 h, respectively. Thomas splint was used to immobilize the limb in all for 1 month and weight-bearing was started after 2 months from injury. Two of them were followed up to 6 months and one was lost to follow up. No evidence of avascular necrosis of femoral head or other complication related to hip dislocation was noted.

Conclusion:

Luxatio erecta femoris is a rare type of hip dislocation and with limited publication. The position of limb on presentation should raise the suspicion of same and diagnosis confirmed through radiological investigations. Usually, this type of dislocation can be managed with closed reduction. If closed reduction is unsuccessful, then a fracture femur or bone chip in the joint could be the cause of the difficulty.

Traumatic Obturator Hip Dislocation with Marginal Femoral Head Fracture in a 15-Year-Old Adolescent: A High-Energy Trauma-A Case Report and a Review of the Literature

We report the case of a 15-year-old boy brought to the emergency department after a bike accident, complaining of an isolated left hip pain. The X-rays showed an obturator hip dislocation treated by closed reduction under general anaesthesia, followed by 6 weeks of discharge. The follow-up MRI performed 6 weeks after the trauma showed an avascular femoral head necrosis, for which we performed multiple retrograde femoral head drilling, completed by the injection of autologue stem cells from the iliaq crest. One year later, the patient has no hip pain, no joint limitation, and can practice BMX at a high level again. The purpose of this report is to make the physicians aware of this rare problem that may be damaging for hip function, especially in young people.

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.