Asymmetric Bilateral Hip Dislocations: A Case Report and Historical Review of the Literature

Abstract

Background: Asymmetric bilateral hip dislocations are a rare injury pattern in which one hip dislocates posteriorly, and the contralateral hip dislocates anteriorly. We report a case of bilateral asymmetric hip dislocations and provide a comprehensive review of all available reports, identifying 104 total cases, which is 70 more than previously reported.

Purpose: To review and evaluate the total body of literature regarding bilateral asymmetric hip dislocations.

Methods: Comprehensive literature review and analysis of all reports of bilateral asymmetric hip dislocations with concurrent case report.

Results and conclusions: Bilateral, asymmetric represent approximately 0.01%-0.02% of all joint dislocations. There has been a substantial increase in the number of case reports in the literature in the last 10 years. Males are more likely than females to incur this injury pattern and the most common mode of injury is motor vehicle accident Urgent closed reduction should be attempted in an efficient and safe manner to avoid potential complications, and open reduction should be considered in irreducible dislocations. Post reduction management should include stability assessment and CT to assess for associated injuries and intraarticular fragments; although no clear guidelines for post-reduction treatment emerged. Common complications include: nerve palsies, AVN and heterotopic ossification.

Figure 1. (a) AP radiograph of right shoulder demonstrating open proximal third humerus fracture, (b) AP radiograph of the right shoulder at 16 months postoperatively, demonstrating healed fracture status post open reduction, internal fixation.

Figure 2. 3-dimensional CT reconstructions of pelvis prior to reduction of bilateral, asymmetric dislocations, (a) AP view, (b) Lateral view of left hip demonstrating anterior, inferior dislocation, (c) Right lateral view of the right hip demonstrating posterior superior dislocation, (d) Right obturator oblique view demonstrating bilateral dislocations.

Figure 3. (a) AP radiograph of pelvis demonstrating right posterior, superior and left anterior, inferior hip dislocations, (b) AP radiograph of pelvis after reduction of both hips demonstrating concentric reductions.

Figure 4. 3-dimensional CT reconstructions of pelvis after reduction of bilateral, asymmetric dislocations, (a) AP view, (b) Lateral view of left hip demonstrating reduction of dislocation, (c) Right lateral view of the right hip demonstrating reduction of dislocation, (d) Right obturator oblique view demonstrating reduction of both dislocations.

Figure 5. Intraoperative fluoroscopic images demonstrating stability (a) AP right hip in neutral position . (b) Right obturator oblique, outlet view with hip in 90° of flexion, (c) AP left hip in neutral position. (d) Left obturator oblique, outlet view with hip in 90° of flexion.

Figure 6. (a) AP radiograph of pelvis at 16 months post-reduction demonstrating continued stability without obvious complications, (b) Left iliac oblique view, (c) Right iliac oblique view.

Figure 7. Gender distribution of reported cases of bilateral, asymmetric hip dislocations. Note the overall gender distribution and increase in number of female cases since 1997.

Figure 8. Incidence of case reports of bilateral, asymmetric hip dislocations in 20-year intervals. Note the dramatic increase in reported cases in the last ten years