ASYMMETRICAL DISLOCATION OF BILATERAL HIP IN AN ADOLESCENT

Abstract

Hip joint being an inherently stable joint requires a significant amount of force to dislocate. Different mechanism of injury causing different pattern of dislocation. We presented a rare injury of simultaneous asymmetrical dislocation of bilateral hip in an adolescent patient following motor vehicle injury.Presentation:15 years old girl, pillion rider sustained a motor vehicle accident whereby she was thrown forward with her right hip adducted and flexed, the knee hit on the motorcycle bumper and her left hip in abduction and knee in flexion hit on the road divider. On admission her left lower limb was flexed, abducted, and externally rotated; in contrast, the right lower limb was flexed, adducted, and internally rotated. A pelvic radiograph (figure1) revealed bilateral hip dislocation with the femoral head displaced antero-inferiorly on the left side and posteriorly on the right side. Closed reduction of the joints was done under sedation and subsequently put on traction. Repeated radiograph showed both hip joints well reduced (Figure 2), skin traction was applied for 5 days and subsequently she was allowed for wheelchair ambulation.Figure 1:X-ray pelvis AP on presentation.Figure 2:X-ray pelvis AP post reductionDiscussion:Bilateral simultaneous hip dislocations are an extremely rare injury (1.25%)1, however bilateral asymmetric dislocations of hip are even rarer. Based on described mechanisms, they ranged from pedestrian being hit by a car to head on collision of vehicles and motorcycle crash. The single common mechanism involved in most of these cases was a sudden deceleration injury which occurred in motor vehicle accidents. Treatment for asymmetrical dislocations are still similar, with concentric reduction still the main goal either closed or open reduction.Conclusion:Asymmetric bilateral hip dislocation is a rare entity especially in adolescents and requires high velocity collision with sudden deceleration injury.Reference: Management of shotgun induced open fractures of the humerus with Ilizarov fixator;2015The Masquelet Technique for Thumb Metacarpal Reconstruction Following Trauma ; JBJS; 2018Muscle reconstruction in reconstructive surgery: soft tissue repair and long bone reconstruction; 2003