Concomitant ipsilateral traumatic dislocation of the hip and knee following high-energy trauma: a case report

Traumatic dislocation of the hip or knee can occur after high-energy trauma and is often associated with concomitant injuries and secondary complications. Concomitant traumatic dislocation of both hip and knee is rare. We describe a case of combined ipsilateral posterior hip dislocation with a posterior acetabular fracture and a complete open knee dislocation with disruption of the popliteal artery that resulted in amputation.     

Bilateral Traumatic Anterior Dislocation of the Hip with an Unstable Lumbar Burst Fracture

Traumatic anterior dislocation of the hip is rare. Bilateral traumatic anterior dislocation is an even rarer injury; indeed, only 5 cases have been reported in the English literature. We describe a case of a bilateral traumatic anterior dislocation of the hip and a concomitant unstable lumbar burst fracture following a mechanism of injury distinctly different from other reports.     

Traumatic posterior hip instability and femoroacetabular impingement in athletes

We describe 3 cases of posterior hip instability associated with femoroacetabular impingement. In each case, we obtained a detailed medical history, performed a physical examination, evaluated imaging, recorded intraoperative findings, and clinically followed the patient for 1 year. Two of the 3 patients sustained a traumatic posterior hip subluxation caused by noncontact injuries. All patients had decreased internal rotation on physical examination, radiographic evidence of acetabular retroversion, a cam lesion, an elevated α angle, and a posterior acetabular rim fracture with associated labral injury. All patients underwent hip arthroscopy and direct repair of the bony acetabular fragment using 3 to 5 suture anchors. One-year follow-up in all cases demonstrated good to excellent results and full return to activities without restriction. Patients with femoroacetabular impingement may be predisposed to traumatic posterior dislocation or subluxation and a concomitant posterior acetabular rim fracture with labral injury. We propose that FAI predisposed these athletes to posterior hip instability.     

The Levine anterior approach for total hip replacement as the treatment for an acute acetabular fracture

The treatment of acetabular fractures in part relies on the selection of a specific surgical approach that allows for accurate reduction of fracture fragments. Moreover, these acetabular approaches were not developed for the insertion of a total hip replacement. Therefore, if a total hip arthroplasty is to be the treatment of an acute acetabular fracture, a single incision that permits reduction of the acetabular fracture fragments and ease of insertion of the arthroplasty components would be desirable. The Levine anterior approach provides both accesses to the anterior wall/column for reduction and fixation and to the femoral shaft for insertion of a total hip replacement. This paper describes that surgical technique and our initial clinical experience with this approach for acute acetabular fractures. A consecutive group of 10 patients with acetabular fractures, all involving the anterior wall/column with articular impaction (>50% of the acetabular roof) including 2 cases with an associated posterior hemitrans-verse component, were reviewed. After fracture reduction and fixation, a hybrid total hip replacement was implanted in all cases with an average acetabular component size of 56 mm (range 52-64). At a mean follow-up of 36 months (range 24-53), all fractures united, and all acetabular components remained fixed with no evidence of migration or loosening. There were 2 complications, a Brooker grade II heterotopic ossification and 1 postoperative anterior dislocation treated successfully with closed reduction and spica cast immobilization. The average Merle d'Aubigné hip score at latest follow-up was 16 (range 13-18). The Levine anterior approach is a reliable, safe, and efficient technique that permits early mobilization of patients with anterior wall/column acetabular fractures requiring a total hip replacement.     

髋臼骨折、髋关节脱位合并坐骨神经损伤的临床分析

目的探讨髋臼骨折、髋关节脱位合并坐骨神经损伤的临床特点及发病机制。方法回顾髋臼骨折、髋关节脱位及髋臼骨折合并髋关节脱位的患者155例(159侧),其中合并坐骨神经损伤35侧。分析髋臼骨折、髋关节脱位的流行病学特点及坐骨神经损伤与髋臼骨折、髋关节脱位分型的关系。结果81.3%的患者为男性,86.5%的患者年龄为20～50岁,83.9%为车祸伤所致。坐骨神经损伤总发病率为22.01%,而在髋臼骨折为17.19%,在单纯髋关节后脱位为12.90%,在髋臼骨折合并髋关节后脱位为36.36%。31侧坐骨神经损伤中48.39%为腓总神经成分损伤,51.61%为腓总神经 胫神经损伤。结论车祸伤是髋臼骨折、髋关节脱位的主要原因,多见于成年男性。坐骨神经损伤主要发生于髋臼后壁、后柱骨折合并髋关节后脱位患者,且腓总神经成分损伤多见。     

Anterior Dislocation of the Hip Associated with an Actebular Fracture: Case Report

Abstract Anterior hip joint dislocation is less common than posterior dislocation. Although fractures of the acetabulum can occur in anterior hip dislocations, they are infrequently. In this article, we report an uncommon lesion in a woman who sustained an anterior dislocation of the hip associated with a fracture of the acetabular wall. Close reduction was performed immediately the initial injury. The patient underwent open reduction and internal fixation since the hip joint was result unstable and the CT scan showed the presence of a bone fragment of the anterior acetabular wall. At 2-year follow-up, the clinical and radiological results are excellent.     

Ipsilateral hip and knee dislocation: Case report and review of literature

Hip and knee dislocations are not uncommon but simultaneous ipsilateral dislocation of the hip and knee joint is rare; consequently, there is an inadequate amount of literature on the subject. We identified only 11 such cases reported in English literature. In the present report, we describe the case of a 23-year-old male patient who presented with ipsilateral hip and knee dislocation on the right side after being involved in a road traffic accident. The hip dislocation was associated with a posterior wall acetabular fracture. The hip as well as the knee joints was reduced in the emergency bay. The patient underwent an urgent fixation of the posterior wall acetabular fracture with delayed ligament reconstruction for the knee dislocation. At one-year follow-up, he had no pain in the hip or knee. There was grade 1 posterior sag but no symptoms of knee instability. Radiographs revealed no evidence of avascular necrosis or arthritis of the femoral head. The normal treatment protocol for individual injury is affected by the simultaneous occurrence of hip and knee dislocation.     

Asymmetrical bilateral traumatic hip dislocation in an adult with bilateral acetabular fracture

This case report aims at presenting a unique case of simultaneous bilateral traumatic dislocation with right side anterior and the left side posterior together with bilateral acetabular fracture. Under general anesthesia, closed reduction of both hips was carried out. The case presented represents an unusual, severe combination of injuries resulting from a high-speed motor-vehicle accident. Traumatic hip dislocation represents a true orthopedic emergency. Given the severity of the associated complications, every effort should be made to ensure prompt diagnosis and immediate therapy.     

3D surgical printing and pre contoured plates for acetabular fractures

We describe the methodical and possibilities of 3D surgical printing in preoperative planning of acetabular fractures showing a case of a 45-year-old with an associated transverse fracture of the left acetabulum with posterior wall fracture, with multiple fragments, and posterior ipsilateral hip dislocation, defending the do it your-self mode.     

Asymmetrical bilateral traumatic fracture dislocation of the hip: a report of two cases

We report on two cases of simultaneous asymmetrical bilateral hip dislocation. Both patients were involved in car accidents. The first case is a 23-year-old man who had a bilateral hip dislocation, anterior on the right side and posterior on the left associated with bilateral femoral head fracture. The second case presented the same dislocations of the hips associated with acetabular fracture on the right side. Closed reduction of the hips was performed in both cases. In the first case the femoral head fragments was subsequently removed. In the second case internal fixation of the acetabular fracture was postponed.     

Asymmetrical bilateral traumatic hip dislocation with ipsilateral acetabular fracture

We report a case of simultaneous asymmetrical bilateral traumatic hip dislocation, with one hip dislocated anteriorly and the other posteriorly, with ipsilateral acetabular fracture, suffered in a traffic accident by a 36-year-old man. Closed reduction of both hips was performed, followed by delayed internal fixation of the acetabular fracture. Received for publication on June 28, 1999; accepted on Oct. 28, 1999     

Bilateral hip dislocation in a 79 years patient

Bilateral simultaneous dislocation of the hip is an unusual occurrence, especially if there is no previous history of hip abnormality or ligamentous laxity. Most of the reports published until now most frequently describe this type of injury in adults. The majority of case reports present patients with ages ranging between 20 and 30 years old, because at this age the bone is strong enough not to suffer a fracture but a dislocation. The oldest patient with bilateral simultaneous dislocation of the hip described in literature (to our knowledge) is 65 years old. We present the case of a 79 year old man that was involved in an agricultural accident in which a heavy load fell on both his feet while he was laying on the ground. Anteroposterior pelvic radiograph reveal bilateral posterior hip dislocation with an associated left-side acetabular fracture and also a minimum displaced anterior left pelvic ring fracture. Both hips were reduced within three hours of presentation by closed manipulation under spinal anaesthesia. Literature search revealed no case presentation that reported a bilateral simultaneous dislocation of the hip in elderly--to our knowledge, this is the first.     

Reduction of high dislocation of the hip using a distraction nail before arthroplasty

We report the case of a 22-year-old woman who underwent plate and screw fixation for a traumatic left acetabular fracture and fixation with cancellous screws for an associated femoral neck fracture. Two months later, the internal fixation became infected and was removed. This resulted in a painful high dislocation of the hip. We solved the problem with continuous soft-tissue distraction using a fully implantable motorised distraction nail in order to reduce the proximal femur prior to total hip arthroplasty. To our knowledge, this is the first time that reduction of a high dislocation of the hip has been performed using such a system.     

Surgical hip dislocation in fixation of acetabular fractures: Extended indications and outcome

BackgroundSurgical hip dislocation has been described as an excellent method for reduction and fixation of acetabular fractures. It allows a 360-degree access to the acetabulum and acetabular dome. However, reproducibility of this technique is still a concern. The primary outcome of this study was to investigate the short term functional and radiological outcome with the use of surgical hip dislocation in acetabular fractures. The secondary outcome was to describe different indications and methods of reduction using this technique.MethodsThis is a retrospective consecutive case series for the use of surgical hip dislocation in acetabular fractures. Between July 2013 and February 2017, we used this technique to manage 36 cases of acetabular fractures. Two patients were lost to follow up leaving 34 patients eligible for the study. All surgeries were done by a 5-years and a 10-years’ experience surgeons in pelvic and acetabular trauma surgeries. Through Gibson approach, we used the technique of surgical hip dislocation as described by the Bernese group. Different methods of fracture reduction were used. Intraoperative grading of cartilage injury was done using Disler's grading system. Postoperative fracture reduction was evaluated using the criteria described by Matta. Clinical evaluation was done using the modified Merle d'Aubigne ? and Postel system.ResultsThe mean intra-operative blood loss was about 700 ± 35.4 ml. The mean units of blood transfused were 1 ± 0.1 unit. The mean surgical time was 135 ± 11.7 minutes.Anatomical reduction was achieved in 27 patients (79.4%). At a mean of 30 ± 16.8 months (median = 26 and IQR 22) follow up, the functional score was excellent in 5 (14.7 %), very good in 8 (23.5%), good in 9 (26.5%), fair in 2 (5.8%), and poor in 10 (29.4%) patients. Four patients (11.7%) developed AVN at a mean of 8 months postoperatively. Conversion to THA was done in 5 patients (14,7%). Trochanteric osteotomy showed osseous healing in all cases. No patient developed nerve injury or infection. One patient developed severe (grade III) heterotopic ossification.ConclusionsBesides the indications of surgical hip dislocation mentioned before as reduction of the anterior column in T and Transverse fractures, associated femoral head fractures, intraarticular fragments, and labral injuries, it can be used in other indications as entrapped posterior wall, roof impaction, pure impaction injuries and cranial extension of the posterior wall fractures. The technique is reproducible; however, the learning curve is steep and needs to be performed by experienced acetabular trauma surgeons.     

Recurrent dislocation of the hip with a "Bankart-type" lesion

A patient with recurrent dislocation of the hip is described. The initial injury had been a posterior dislocation without associated fracture of the acetabular wall, and the hip had not been immobilised or protected from weight-bearing during treatment. Exploration of the hip for recurrence revealed disruption of the posterosuperior acetabular labrum with formation of a pouch between the posterior acetabular wall and the short rotator muscles. We have found no previous report of this lesion, which resembles a Bankart lesion of the shoulder. Repair using a bone block is described.     

髋臼骨折的手术治疗

目的 探讨髋臼骨折的分型、手术入路的选择及手术效果.方法 手术治疗22例髋臼骨折患者,后壁骨折和后柱加后壁骨折选择K-L入路,前柱、前壁骨折及横断骨折选择髂腹股沟入路,前后移位明显的横断骨折、T形骨折、双柱骨折选择前后联合入路.结果 22例均获随访,时间6个月~5年,骨折6~9个月均愈合.按Matta评定标准:解剖复位 9例,满意复位13例.根据改良的Merle d′Aubigne-Poster髋关节功能评分标准:优7例,良10例,可4例,差1例.1例股骨头坏死,3例创伤性关节炎,2例异位骨化.结论 按髋臼骨折的分型选择合适的手术入路和良好的骨折复位内固定是获得满意疗效的前提.     

Acetabular morphological variation in Asian patients with femoral neck fracture: A three-dimensional CT-based study

AimsThe acetabular morphology varies greatly among individuals, and hypoplasia is more common in Asia than in Europe. Dislocation after bipolar hip arthroplasty (BHA) for femoral neck fracture occurs at a constant rate, and is affected by the acetabular morphology. This study aimed to clarify individual differences in the acetabula of Asian patients with displaced femoral neck fractures.Patients and methodsFifty patients with displaced femoral neck fractures were assessed (50 fractured hips, 50 non-fractured hips). On CT corrected by the anterior pelvic plane, the 100 hips were assessed regarding acetabular coverage (six parameters), acetabular depth (two parameters), and acetabular opening angle (four parameters). Additional parameters related to the fracture and sex were examined. The percentile of each parameter was shown for all hips.ResultsThere was no patient with hip dysplasia defined as superior acetabular sector angle (SASA) less than 110° Compared with men, women had a significantly smaller anterior acetabular sector angle (AASA) (p = 0.016), and significantly larger acetabular inclination angle (p = 0.006) and acetabular index angle (p = 0.034). In the group with a normal SASA, seven hips (7.3%) had an anterior wall defect (AASA<50°) and five hips (5.2%) had a posterior wall defect (posterior acetabular sector angle<90°).ConclusionOlder adults with femoral neck fractures can have anterior wall and posterior wall defects, even if their SASA is normal. Hidden acetabular dysplasia may be related to post-BHA dislocation. So, our results suggest that is important to accurately evaluate the acetabulum of patients with femoral neck fracture before surgery.     

Posterior acetabular arc angle of unstable posterior hip fracture–dislocation

Purpose

Posterior hip fracture–dislocation needs stability evaluation. A previous study in the normal acetabulum has shown that the coronal posterior acetabular arc angle (PAAA) could be used to assess an unstable posterior hip fracture. Our study was designed to assess PAAA of unstable posterior hip fracture–dislocation and whether posterior acetabular wall fracture involves the superior acetabular dome.

Methods

Using coronal computed tomography (CT) of the acetabulum and 3D reconstruction of the lateral pelvis, we measured coronal, vertical PAAA and posterior acetabular wall depth of 21 unstable posterior hip fracture–dislocations and of 50 % normal contralateral acetabula. Posterior acetabular wall fracture was assessed to determine whether the fracture involved the superior acetabular dome and then defined as a high or low wall fracture using vertical PAAA in reference to the centroacetabulo–greater sciatic notch line.

Results

The coronal PAAA of unstable posterior hip fracture–dislocations and of 50 % of the posterior acetabular wall of normal the contralateral acetabulum were 54.48° (9.09°) and 57.43° (5.88°) and corresponded to 15.06 (4.39) and 15.61 (2.01) mm of the posterior acetabular wall without significant difference (p > 0.05). The vertical PAAA of unstable posterior hip fracture–dislocation was 101.67° (20.44°). There were 16 high posterior acetabular wall fractures with 35.00 (16.18) vertical PAAA involving the acetabular dome and 5 low wall fractures. High posterior wall fractures resulted in four avascular necroses of the femoral head, three sciatic nerve injuries and one osteoarthritic hip.

Conclusion

Coronal and vertical PAAA of unstable posterior hip fracture–dislocations were 54.48° and 101.67°. Vertical PAAA assesses high or low posterior acetabular wall fracture by referring to the centroacetabulo–greater sciatic notch line. High posterior wall fracture seems to be the most frequent and is involved with many complications.     

Arthroskopie nach Trauma des Hüftgelenks

Intra-articular injuries are common after dislocation and fracture of the hip joint and can be addressed using hip arthroscopy. The most common indications for this procedure are loose bodies, labral tears and chondral defects. In addition, preexisting femoroacetabular impingement can be addressed at the time of surgery. Arthroscopically guided fracture reduction and fixation has been described. We present two case reports of intra-articular lesions after traumatic hip dislocation. The first is a case of a man with an anterior labral tear and loose bodies after closed hip reduction. The second case is a man with a large anterior labral tear with preexisting femoroacetabular impingement. Both of them were treated by arthroscopic debridement of the unstable labrum. In addition loose bodies were removed in the first patient and a femoral osteoplasty was performed in the second patient. Hip arthroscopy has proven to be a safe and effective surgical technique for treating specific post-traumatic lesions and preexisting femoroacetabular impingement. The current case reports provide an overview of the indication for hip arthroscopy following traumatic injuries to the hip.