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Galanis C, Konstantinou A, Giotis D, Tsiampas D, Plakoutsis S, Vardakas D, Konstantinidis C. Pure Posterior Native Hip Dislocation Following Low-Energy Injury - a Rare Case Report. MAEDICA 2024; 19:186-190. [PMID: 38736916 PMCID: PMC11079731 DOI: 10.26574/maedica.2024.19.11.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Hip dislocations are traumatic injuries that commonly derive from high energy trauma such as traffic accidents or falls from great heights. In addition, these injuries present an increased incidence after partial or total hip arthroplasty in elderly patients. Associate literature dictates that in case of a native hip dislocation, early reduction is crucial for avoidance of further complications such as avascular necrosis of the femoral head and post traumatic arthritis. In this article, we present a rare case of a native pure posterior hip dislocation after low-energy trauma. We also demonstrate the treatment and follow-up algorithm concerning this kind of injury.
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Affiliation(s)
- Charilaos Galanis
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Alkisti Konstantinou
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Dimitrios Giotis
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Dimitrios Tsiampas
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Sotiris Plakoutsis
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Dimitrios Vardakas
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Christos Konstantinidis
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
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Galanis C, Konstantinou A, Giotis D, Tsiampas D, Plakoutsis S, Vardakas D, Konstantinidis C. Pure Posterior Native Hip Dislocation Following Low-Energy Injury - a Rare Case Report. MAEDICA 2024; 19:186-190. [PMID: 38736916 PMCID: PMC11079731 DOI: 10.26574/maedica.2024.19.1.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
Hip dislocations are traumatic injuries that commonly derive from high energy trauma such as traffic accidents or falls from great heights. In addition, these injuries present an increased incidence after partial or total hip arthroplasty in elderly patients. Associate literature dictates that in case of a native hip dislocation, early reduction is crucial for avoidance of further complications such as avascular necrosis of the femoral head and post traumatic arthritis. In this article, we present a rare case of a native pure posterior hip dislocation after low-energy trauma. We also demonstrate the treatment and follow-up algorithm concerning this kind of injury.
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Affiliation(s)
- Charilaos Galanis
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Alkisti Konstantinou
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Dimitrios Giotis
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Dimitrios Tsiampas
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Sotiris Plakoutsis
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Dimitrios Vardakas
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
| | - Christos Konstantinidis
- Department of Orthopedics & Trauma, General Hospital of Ioannina "G. Hatzikosta", 45500 Ioannina, Greece
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Megerian MF, O'Donnell EF, Saiz AM, Fitzpatrick EP, Lee MA, Soles GL, Campbell ST. Irreducible posterior hip dislocation in the setting of a multifocal displaced pelvic ring injury: A case report. Trauma Case Rep 2023; 45:100836. [PMID: 37200771 PMCID: PMC10185737 DOI: 10.1016/j.tcr.2023.100836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/20/2023] Open
Abstract
Case report Traumatic hip dislocations require prompt diagnosis and reduction to preserve the native joint. The classic irreducible posterior hip fracture-dislocation has been described as an immobile, slightly flexed, and internally rotated hip on physical exam. Classically, this irreducible pattern is associated with an ipsilateral femoral head fracture. The purpose of our report is to present an irreducible posterior hip dislocation with preserved motion in the setting of an unstable pelvic ring injury without associated femoral head pathology. Despite lacking clinical features of an irreducible hip, closed reduction in the emergency and operating rooms was unsuccessful, even after frame application for pelvis stability. Persistent irreducibility necessitated open reduction, where the femoral head was found to be buttonholed through the posterior hip capsule and blocking reduction. Conclusion A posteriorly dislocated hip with preserved motion in the setting of a concomitant unstable pelvic ring injury may belie the true locked nature of the femoroacetabular dislocation and high suspicion for femoral head incarceration is required. The description of this unique irreducible fracture pattern and the stepwise approach used for reduction may be useful for other surgeons who may encounter similar patterns of injury.
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Affiliation(s)
- Mark F. Megerian
- Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
- Corresponding author at: Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH 44106, United States of America. @m_megerian
| | - Edmond F. O'Donnell
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, United States of America
| | - Augustine M. Saiz
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, United States of America
| | - Ellen P. Fitzpatrick
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, United States of America
| | - Mark A. Lee
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, United States of America
| | - Gillian L.S. Soles
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, United States of America
| | - Sean T. Campbell
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, United States of America
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Xu Y, Lv M, Yu SQ, Liu GP. Closed reduction of hip dislocation associated with ipsilateral lower extremity fractures: A case report and review of the literature. World J Clin Cases 2022; 10:12654-12664. [PMID: 36579117 PMCID: PMC9791526 DOI: 10.12998/wjcc.v10.i34.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/17/2022] [Accepted: 11/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Traumatic hip dislocation usually occurs following high-velocity trauma. It is imperative that the dislocation be reduced in a timely manner, especially in a closed manner, as an orthopedic emergency. However, closed reduction can hardly be achieved in patients who also have ipsilateral lower extremity fractures. Herein, we focus on hip dislocation associated with ipsilateral lower extremity fractures, excluding intracapsular fractures (femoral head and neck fractures), present an early closed hip joint reduction method for this injury pattern, and review the literature to discuss the appropriate closed reduction technique for this rare injury pattern.
CASE SUMMARY We report a case of a 37-year-old male who sustained a left acetabular posterior wall fracture, an ipsilateral comminuted subtrochanteric fracture and dislocation of the hip. The hip dislocation was reduced urgently in a closed manner using the joy-stick technique with a T-shaped Schanz screw. The fractures were reduced and fixed as a 2nd-stage surgery procedure. At the 17-month postoperative follow-up, the patient had full range of motion of the affected hip.
CONCLUSION Closed reduction of a hip dislocation associated with ipsilateral lower extremity fractures is rarely achieved by regular maneuvers. Attempts at closed reduction, by means of indirectly controlling the proximal fracture fragment or reconstructing the femoral leverage rapidly with the aid of various external reduction apparatuses, were shown to be effective in some scenarios. Mandatory open reduction is indicated in cases of failed closed reduction, particularly in irreducible dislocations.
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Affiliation(s)
- Yong Xu
- Department of Orthopaedics, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Ming Lv
- Department of Orthopaedics, Zibo Central Hospital, Shandong University, Zibo 255000, Shandong Province, China
| | - Shu-Qiang Yu
- Department of Orthopaedics, The Fourth People's Hospital of Zibo, Zibo 255000, Shandong Province, China
| | - Guang-Ping Liu
- Department of Orthopaedics, Zibo Central Hospital, Shandong University, Zibo 255000, Shandong Province, China
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Nohmi S, Oishi H, Sakamoto Y. Posterior hip fracture-dislocation associated with posterior wall fracture of the acetabulum and ipsilateral comminuted trochanteric fracture of the femur: A case report. Int J Surg Case Rep 2022; 94:107075. [PMID: 35427888 PMCID: PMC9026913 DOI: 10.1016/j.ijscr.2022.107075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/09/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Traumatic posterior dislocation of the hip is often associated with fractures of the femoral head and posterior wall of the acetabulum. However, hip fracture-dislocation that includes the posterior wall of the acetabulum and the ipsilateral femoral trochanter is rare. There is no consensus on the bone that should be operated on first, the operative position, and the choice of implant for femoral fixation. Case presentation A 67-year-old man was brought to our emergency department after a 2-m fall. He was diagnosed with a hip fracture-dislocation associated with posterior wall acetabular fracture and ipsilateral femoral trochanteric fracture. Surgical reconstruction was performed with intramedullary nail (IMN) fixation of the femoral trochanteric lesion, followed by anatomically rigid acetabular fixation in the lateral decubitus position. At the 5-year follow-up after the injury, the patient showed good objective and subjective clinical outcomes. Clinical discussion Fixing the femur first could allow an easier reduction and traction. The lateral decubitus position was useful, because fixation of the femur and the acetabulum could be performed without changing the position. When fixing the femoral trochanteric lesion, attention was paid to reduce the anteromedial cortex of the proximal fragment extramedullarly to the distal fragment to prevent complications such as cutout and implant breakage. Conclusion Anatomically rigid fixation of the posterior wall of the acetabulum secondary to IMN fixation of the femur, with anteromedial cortical support in the lateral decubitus position, could achieve good objective and subjective clinical outcomes. We report a case of posterior hip fracture-dislocation with fractures of posterior wall and ipsilateral femoral trochanter This is a rare clinical presentation For treatment, femoral intramedullary nail fixation is performed first Then, acetabular posterior wall fixation is performed in lateral decubitus position Anteromedial cortex of proximal fragment is reduced extramedullarly to distal fragment
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Affiliation(s)
- Shuya Nohmi
- Department of Orthopaedic Surgery, Misawa City Hospital, 164-65 Horiguchi, Misawa, Misawa-shi, Aomori 033-0022, Japan.
| | - Hirotaka Oishi
- Department of Orthopaedic Surgery, Hachinohe City Hospital, 3-1-1 Tamukai, Hachinohe-shi, Aomori 031-8555, Japan
| | - Yukiko Sakamoto
- Department of Orthopaedic Surgery, Towada City Central Hospital, 14-8 Nishi12-bancho, Towada-shi, Aomori 034-0093, Japan
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Desai KB. Decoding the behaviour of extracapsular proximal femur fracture- dislocation - A systematic review of a rare fracture pattern. J Clin Orthop Trauma 2021; 18:157-170. [PMID: 34012770 PMCID: PMC8111678 DOI: 10.1016/j.jcot.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/22/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Proximal femoral extracapsular fractures with associated ipsilateral hip dislocation is an extremely rare pattern of injury. These fractures may be associated with a spectrum of severity from isolated trochanteric fractures to comminuted intertrochanteric and subtrochanteric fractures with hip dislocation. To date, this pattern of injury is not described in any injury classification system and no clear cut guidelines for the same are available. The aim of this review is to provide an evidence based pooled analysis of the existing literature and develop guidelines that help surgeons tackle this rare injury pattern. METHODS A comprehensive review of the literature was undertaken using the PRISMA. Case reports and series of Extracapsular proximal femoral fracture dislocations published in PubMed, EMBASE, Springer, OvidSP, ScienceDirect, Web of Science and Google scholar between inception of journals to May 2020 were included in the review. A pooled analysis comparing the demography, pattern of the fracture, mode and mechanism of injury with the clinical and radiological outcome and complications was performed. RESULTS 52 cases from 46 case studies were included in the pooled analysis. There was a near significant association between avascular necrosis and mean time to reduction (p = 0.0865). Individuals with compound injury had 10.12 times higher risk of avascular necrosis (p = 0.009). No significant association between the pattern of proximal femur fracture and incidence of avascular necrosis (p = 0.116, chi-square). There was no significant association between polytrauma and poor clinical outcomes. (p = 0.231). CONCLUSIONS Principles of damage control orthopaedics should be followed in unstable patients with this rare fracture dislocation. Percutaneous Schanz screw reduction manoeuvre can be attempted gently with a low threshold to perform an open reduction. Every attempt at salvaging the fractured hip must be performed in young individuals with an arthroplasty standby for comminuted and unreconstructable cases.
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Affiliation(s)
- Keyur B. Desai
- Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India
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Desai KB, Dhamangaonkar AC. A case of posterior HIP dislocation with intertrochanteric fracture: Beware of the sharp calcar spike. J Clin Orthop Trauma 2019; 10:975-980. [PMID: 31528079 PMCID: PMC6739243 DOI: 10.1016/j.jcot.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 12/26/2022] Open
Abstract
Posterior dislocation of hip is commonly associated with acetabular lip fractures. Involvement of neck, trochanter or intertrochanteric region is uncommon. Very few cases of posterior hip dislocation with ipsilateral intertrochanteric fracture in the absence of head or acetabular fracture have been reported in the literature. We report such a case in a 19yr male treated with open reduction and internal fixation with sliding hip screw with good functional and radiological outcome at 1 year. Being an extremely rare form of injury, such an injury pattern does not exist in present classification systems. There is a need to revise the existing classification systems and formulate a protocol for the management of the same. Such fractures may also be associated with a sharp calcar spike of the proximal fragment impinging femoral vessels and branches. Attempt at closed reduction without adequate anatomical orientation of the spike can lead to hazardous vascular consequences.
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