Assaf, Samer

Ghanem, Ghadi

eScholarship - University of California

UC IrvineJournal of Education and Teaching in Emergency MedicineTitleBilateral Posterior Hip Dislocation in an Unrestrained DriverPermalinkhttps://escholarship.org/uc/item/084919z6JournalJournal of Education and Teaching in Emergency Medicine, 2(4)AuthorsAssaf, SamerGhanem, GhadiPublication Date2017DOI10.5070/M524036775Copyright InformationCopyright 2017 by the author(s).This work is made available under the terms of a Creative Commons Attribution License, available at https://creativecommons.org/licenses/by/4.0/ Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of California Return: Calibri Size 10 3 Bilateral Posterior Hip Dislocation in an Unrestrained Driver  Samer Assaf, MD* and Ghadi Ghanem* *University of California, Irvine, Department of Emergency Medicine, Orange, CA Correspondence should be addressed to Samer Assaf, MD at sassaf86@gmail.com  Submitted: July 20, 2017; Accepted: September 9, 2017; Electronically Published: October 15, 2017; https://doi.org/10.21980/J8HD0C   Copyright: © 2017 Assaf, et al. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/       Return: Calibri Size 10 4   History of present illness:  A 24-year-old male was brought in by paramedics status post motor vehicle collision into an electric pole and tree at high speed. The patient was an unrestrained driver who required extrication. The patient complained of left hip pain, left foot pain, and difficulty extending his bilateral lower extremities. He denied numbness or tingling to his lower extremities. The patient had normal vitals; his bilateral lower extremities were held in flexion at the hips, but otherwise had no obvious injuries. The patient’s pelvis was stable with palpable distal pulses and intact motor and sensory function of his distal lower extremities.  Significant findings: The initial radiograph of the pelvis revealed bilateral hip dislocations. Small bony fragments were noted in the right hip joint, suggestive of an underlying fracture. The sacroiliac joints and the pelvic ring were intact. In the emergency department, bilateral hip reductions were performed using the Captain Morgan technique.1 The post-reduction film showed reduction of the bilateral hip dislocations with extensive comminuted and displaced fractures of the right and left acetabula.   Discussion: Bilateral hip dislocations are extremely rare, occurring in only 1% of all hip dislocations,2 and require immense force, typically occurring in MVCs (74%).3-7 Associated injuries include fracture of the acetabulum or femoral head, sciatic nerve damage, and obstruction of the blood supply to the femoral head.8 X-ray imaging and computed tomography (CT) scans are used to assess the injury and to detect intra-articular fragments.3 Definitive treatment is achieved by closed reduction if possible; otherwise open reduction is utilized.9 Post-reduction therapy includes a non-weight-bearing period of time. Complications include avascular necrosis of the femoral head, osteonecrosis, and posttraumatic arthritis, the occurrence of which can be decreased by early reduction.4,10-12 This patient underwent bilateral closed hip reductions in the ER in conjunction with orthopedic surgery and underwent operative management of his pelvic fractures at a later date.   Topics: Posterior hip dislocation, dislocation reduction, pelvis, radiograph, trauma.  References:  1. Hendey W, Avila A. The Captain Morgan technique for the reduction of the dislocated hip. Ann Emerg Med, 2011;58(6):536-540. doi: 10.1016/j.annemergmed.2011.07.010 2. Janzen L, Munk L, Connell G, et al.  Bilateral traumatic posterior hip dislocation: CT findings. Australas Radiol, 1995;35(3):264-265. 3. Cobar A, Cahueque M, Bregni M, Altamirano M. An unusual case of traumatic bilateral hip dislocation without fracture. J Surg Case Rep. 2017(5):rjw180. doi: 10.1093/jscr/rjw180 4. Buckwalter J, Westerlind B, Karam M. Asymmetric bilateral hip dislocations: a case report and historical review of the literature. Iowa Ortho J. 2015;35:70-91. 5. Pietrafesa CA, Hoffman JR. Traumatic dislocation of the hip. JAMA. 1983;249(24):3342-3346. doi: 10.1001/jama.1983.03330480048029 6. Sneath RJ, Morgan NP. Bilateral traumatic anterior dislocation of the hip joint. J Accid Emerg Med. 1997;14(6):391. 7. Lima LC, Nascimento RA, de Almeida VMT, et al. Epidemiology of traumatic hip dislocation in patients treated in Ceará, Brazil. Acta Ortopedica Brasileira. 2014;22(3):151-154. doi: 10.1590/1413-78522014220300883 8. Sanders S, Tejwani N, Egol KA. Traumatic hip dislocation - a review. Bull NYU Hosp Jt Dis. 2010;68(2):91-96.  9. Lo B. Asymmetrical bilateral hip dislocation. West J Emerg Med. 2013;14(5):452. doi: 10.5811/westjem.2013.2.15968  Return: Calibri Size 10 5   10. Hougaard K, Thomsen PB. Coxarthrosis following traumatic posterior dislocation of the hip. J Bone Joint Surg Am. 1987;69:679-683. 11. Sahin, V, Karakaş, ES, Aksu S, Atihan D, Turk CY, Halici M. Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study. J Trauma. 2003;54(3):520-529. doi: 10.1097/01.TA.0000020394.32496.52 12. Abdulfattah Abdullah AS, Abdelhady A, Alhammoud A. Bilateral asymmetrical hip dislocation with one side obturator intra-pelvic dislocation. Int J Surg Case Rep. 2017;33:27-30. doi: 10.1016/j.ijscr.2017.02.012  

Bilateral Posterior Hip Dislocation in an Unrestrained Driver

Abstract

Similar works

Full text

Available Versions

eScholarship - University of California