Bilateral Hip Dislocation Research Articles

Bilateral Asymmetrical Hip Dislocations after Falling from Height: A Case Report and Literature Review

Background: Hip dislocations, constituting 2-5 percent of all joint dislocations, predominantly present as posterior dislocations. Bilateral hip dislocations are rare, accounting for 1.25% of cases. Associated fractures often involve the proximal femur and acetabulum. Case Report: A 60-year-old man with no prior hip trauma history sustained bilateral hip dislocations after a 6-meter fall. Initial assessments and a hip computed tomography (CT) scan confirmed posterior dislocation of the right hip and anterior dislocation of the left hip. The patient underwent a successful closed pelvic reduction operation four hours post-injury, as confirmed by a post-reduction CT scan. Conclusion: The study, encompassing 11 relevant studies and 208 patients, predominantly men (81%), revealed that asymmetrical bilateral hip dislocations were exceptionally rare (0.01-0.02 percent). Contrary to expectations, this study challenges the presumed stronger association of traffic accidents with bilateral dislocations, presenting a statistically significant association between the type of dislocation and trauma mechanism. Associated fractures, such as acetabulum fractures in unilateral cases and posterior edge fractures in bilateral cases, varied. Avascular necrosis (AVN), a common complication, was not observed in the current case, where reduction occurred within the critical 6-hour timeframe. This report contributes valuable insights into the characteristics and associations of asymmetric bilateral hip dislocations, emphasizing the importance of prompt intervention to mitigate complications. Further research is needed to validate these findings and explore underlying patterns in this rare clinical scenario.

Congenital dislocation of the knee complicated with bilateral hip dislocation: a case report and literature review

BackgroundCongenital dislocation of the knee is characterised by excessive knee extension or dislocation and anterior subluxation of the proximal tibia, and this disease can occur independently or coexist with different systemic syndromes. Nevertheless, significant controversy surrounds treating this disease when combined with hip dislocation. This paper presents a case of a 4-month-old patient diagnosed with bilateral hip dislocation combined with this disease. The study discusses the pathophysiology, diagnosis, and treatment methods and reviews relevant literature.Case presentationWe reported a case of a 4-month-old female infant with congenital dislocation of the right knee joint, which presented as flexion deformity since birth. Due to limitations in local medical conditions, she did not receive proper and effective diagnosis and treatment. Although the flexion deformity of her right knee joint partially improved without treatment, it did not fully recover to normal. When she was 4 months old, she came to our hospital for consultation, and we found that she also had congenital dislocation of both hip joints and atrial septal defect. We performed staged treatment for her, with the first stage involving surgical intervention and plaster orthosis for her congenital dislocation of the right knee joint, and the second stage involving closed reduction and plaster fixation orthosis for her congenital hip joint dislocation. Currently, the overall treatment outcome is satisfactory, and she is still under follow-up observation.ConclusionsEarly initiation of treatment is generally advised, as nonsurgical methods prove satisfactory for mild cases. However, surgical intervention should be considered in cases with severe stiffness, unresponsive outcomes to conservative treatment, persistent deformities, or diagnoses and treatments occurring beyond the first month after birth.

Clinical and genetic analysis of trichohepatoneurodevelopmental syndrome caused by a CCDC47 variant

Trichohepatoneurodevelopmental syndrome is an extremely uncommon autosomal recessive disorder resulting from variants in the CCDC47 gene, which encodes a Ca2+-binding endoplasmic reticulum (ER) transmembrane protein. To date, only four patients with CCDC47 deficiency have been reported, all of them with homozygous truncating CCDC47 variants. For this study, a Chinese family was recruited, which included a patient diagnosed with trichohepatoneurodevelopmental syndrome. Whole exome sequencing (WES) identified the proband's novel homozygous CCDC47 variation (NM_020198: c.634C > T(p.Arg212*). The variant was confirmed to be segregating in the proband and her unaffected relatives through Sanger sequencing. The patient described exhibited a clinical phenotype similar to that of patients with the CCDC47 variant. Compared to reported cases with CCDC47 pathogenic variants, our patients showed a novel complication of hearing impairment. In addition, brain abnormalities, small feet, bilateral hip dislocation, hip dysplasia, overlapping toes, pectus excavatum, scoliosis and narrow chest were not observed in our patient. We also examined five different variations and their corresponding phenotypes from five patients, both in current and previous research. Although some clinical manifestations of trichohepatoneurodevelopmental syndrome were highly variable, the most common phenotypes observed in these patients include microcephaly, profound intellectual disability, severe global development delay, pronounced growth restriction, hypotonia, woolly hair, facial dysmorphism, respiratory and visual abnormalities, gastrointestinal abnormalities, liver dysfunction, pruritus, skeletal and limb abnormalities, congenital heart defects and immunodeficiency. The present report is the first of a Chinese infant with homozygous variant in the CCDC47 gene. We expanded the genetic and phenotypic spectrum associated with trichohepatoneurodevelopmental syndrome.

Asymmetric bilateral hip dislocation: A case report

Bilateral hip dislocation is a rare phenomenon in which one hip dislocates posteriorly and the contralateral hip dislocates anteriorly. We describe a case of a 32-year-old man with bilateral hip dislocation. The patient arrived at our emergency room 30 min after the trauma, was hemodynamically stable, conscious with a Glasgow Coma Scale of 15, and was unable to stand or even sit. Within 40 min of admission, both hips were lowered using closed manipulation. The right hip was reduced using the Allis maneuver while the left hip was reduced using the reverse Bigelow’s maneuver while lying in the lateral decubitus posture. Before the reduction, clinical management and radiological planning are required. The advanced trauma life support protocol must be followed when properly treating associated lesions.

The Use of Peripheral Nerve Block and Intra-articular Steroid Injection for Pain Management in an Adolescent with Hutchinson-Gilford Progeria Syndrome: A Case Report.

Hutchinson-Gilford Progeria Syndrome (HGPS) is a rare genetic disorder causing accelerated aging and age-related pathologies. Weighing benefits and risks on doing surgical versus conservative pain management require multidisciplinary planning and consideration in HGPS patients. This presents a case of a 15-year-old patient with HGPS with severe pain from bilateral hip dislocation managed with peripheral nerve block and steroid injection. This afforded her immediate pain relief allowing her to undergo physical rehabilitation comfortably.

Prevalence of Breech Presentation and Other Gestational/Delivery Characteristics Among Patients Born With Developmental Dysplasia of the Hip.

Introduction Developmental dysplasia of the hip (DDH) is the most common congenital disability in newborns. The condition can range from a slight laxity in the hip joint to secondary femoral head injury, early osteoarthritis (OA), and mobility issues. There are several risk factors for DDH, including positive family history, female sex, breech presentation, and the presence of clubfoot. Early detection and treatment are crucial to avoidlong-term hip dysplasia and arthritis, which can cause difficulty in walking and discomfort. Breech presentation, in particular, is a significant risk factor for DDH, with spontaneous vaginal birth increasing the risk of hip pathology and instability compared to elective Caesarean section. However, whether breech presentation continues to be a risk factor for DDH in preterm children is unknown. Objective and methods This study aimed to investigate the prevalence of breech presentation and other gestational/delivery characteristics among newborns diagnosed with DDH.This retrospective study was conducted at Abha Maternity and Children Hospital,Abha, Saudi Arabia, over a period of six months. Data were collected from medical records of DDHcases diagnosed between 2016 and 2023. Data analysis was performed using Microsoft Excel (MicrosoftCorporation, Redmond, Washington, United States)and IBMSPSSStatistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). Descriptive statistics and statistical tests were used to analyze the data. Results Most of the diagnosed children were female (86.7%), and bilateral hip dislocation (40%) was the most common presentation. X-ray was the most common diagnostic tool (48.3%), and operative management was the most common management strategy (73.3%). A positive family history of DDH was reported in more than one-third of cases. The study also analyzed the association between complications during pregnancy and various factors such as mode of delivery, presentation at delivery, gestational age at delivery, and associated maternal diseases. The difference in complication rates between women who delivered via C-section and those who delivered vaginally was insignificant (p = 0.14). Similarly, the difference in complication rates between women with breech and cephalic presentation was not statistically significant (p = 0.094). The difference in complication rates between women who delivered preterm, at term, or post-term was also not statistically significant (p = 0.578). Furthermore, the association between complications during pregnancy and pregnancy-associated maternal diseases was not statistically significant (p = 1.00). Conclusion DDH is a significant health issue in newborns, leading to long-term mobility problems and discomfort. Positive family history of DDH is a significant risk factor. Breech presentation was not significantly associated with DDH in preterm children, and no significant associations were found between complications during pregnancy and various factors. Early detection and treatment of DDH are crucial for preventing long-term complications. Family history should be considered an important risk factor, emphasizing the need for screening programs in families with a history of DDH.

Selective sonographic screening for developmental dysplasia of the hip – increasing trends in late diagnosis

There are concerns that selective sonographic screening for developmental dysplasia of the hip (DDH) may be suboptimal. Our aim was to test this hypothesis by identifying trends in presentation and surgical treatment in patients with DDH. This is a retrospective review of children born between 1997-2018 who were treated surgically for DDH at our sub- regional paediatric orthopaedic unit. Demographic data, risk factors, age of diagnosis and surgical treatments were analysed. Late diagnosis was defined as greater than 4 months. 103 children (14 male, 89 female) underwent surgery. 93 hips were operated for dislocation and 21 for dysplasia. 13 patients presented with bilateral hip dislocations. The median age at diagnosis was 10 months (95% CI: 4-15). 62/103 (60.2%) were diagnosed late (after 4 months) and the median age for diagnosis in this group was 18.5 months (95% CI: 16-20.5). Significantly more patients were referred late (p=0.0077). The presence of risk factors (breech presentation or family history) was associated with early diagnosis. Over the duration of our study the operation rate per 1000 live births gradually increased, and on Poisson regression analysis there was a statistically significant increasing trend towards late diagnosis in recent years (p=0.0237), which necessitated more aggressive surgical management. In the UK, the current selective sonographic screening programme for DDH has shown a deterioration over the years of this study and this questions its current effectiveness. It appears that the majority of irreducible hip dislocations are diagnosed late, with an increased need for surgical management.

Traumatic Bilateral Hip Dislocation: A Case Report and Review of the Literature

Traumatic Bilateral Hip Dislocation: A Case Report and Review of the Literature

P.221 Improvement in respiratory and bulbar function in two patients with SMALED2B

Pathogenic variants in <i>BICD2</i> are implicated in lower extremity predominant spinal muscular atrophy type 2B (SMALED2B). Here we report two patients with SMALED2B due to <i>de novo</i> pathogenic variants in <i>BICD2</i>. The first patient had poor fetal movement. She was born full term and noted to have arthrogryposis, low birth weight, dysmorphic features, bilateral femur fractures and hip dislocations, congenital vertical talus and scoliosis. Electrodiagnostic studies showed chronic axonal motor neuropathy. A muscle biopsy of the gastrocnemius showed extensive fibrofatty replacement. Electron microscopy of the sural nerve showed axonal degeneration and regeneration. Brain MRI showed mild cerebellar atrophy, enlargement of the frontal horns, and reduced size of the optic nerves and chiasm. Additional features included intellectual disability, kyphosis, tremors, choreiform movements and exotropia. Whole exome sequencing (WES) revealed a c.2080C>T variant in <i>BICD2</i>. The second patient had arthrogryposis and polyhydramnios identified prenatally. He was born at 33 weeks and noted to have micrognathia, a large anterior fontanelle and bilateral femur fractures. Electrodiagnostic studies showed low compound muscle action potential amplitudes, likely due to diffuse muscle hypoplasia. MRI of musculature and brain showed near complete absence of skeletal muscles in the extremities and bifrontal white matter volume loss. Additional features included intellectual disability, facial weakness, ptosis, bilateral undescended testes, conductive hearing loss and scoliosis. WES identified a c.1636_1638del variant in <i>BICD2</i>. Both patients had gastrostomy and tracheostomy placement shortly after birth. Patient 1 is now 20 years old. She now only requires nocturnal BiPAP and feeds orally with supplementation via gastrojejunostomy tube. Patient 2 is 7 years old and has not required assisted ventilation since he was 5, but is still fed via gastrostomy. Despite severe <i>in utero</i> presentations, these patients demonstrate that the long-term clinical course for patients with SMALED2B may be more favorable than previously reported.

Bilateral Traumatic Dislocation Diverging from the Hip

Traumatic bilateral hip dislocation is very rare; 56 cases have been reported in the literature so far, the first in 1936 by Marquardt. We report a case of bilateral divergent dislocation of the hip with 6 months of follow-up.

Bilateral Hip Dislocation: Unusual Injury Mechanism

Bilateral Hip Dislocation: Unusual Injury Mechanism

Ehlers-Danlos Syndrome Type Arthrochalasia: A Systematic Review.

Ehlers–Danlos syndrome type arthrochalasia (aEDS) is a rare genetic disease characterized by severe generalized joint hypermobility, bilateral congenital hip dislocation, skin hyperextensibility, muscle hypotonia, and mild dysmorphic features. It is an autosomal dominant connective tissue disease causing defects in collagen, associated with two genes, COL1A1 or COL1A2. Only about 42 cases have been published worldwide. Treatment is currently symptomatic and focuses on increasing the quality of life of these patients, as there is no curative treatment. The main objective of the review was to update information on Ehlers–Danlos syndrome type arthrochalasia from scientific publications. The review report was carried out in accordance with the criteria of the Preferred Reporting Items for Systematic reviews and MetaAnalyses (PRISMA) review protocol, by searching Orphanet, OMIM, PubMed, and Scopus, as well as free sources. A total of 20 articles were analyzed, which, after analysis, provide an updated report that aims to establish a solid starting point for future lines of research.

Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries.

Introduction: Traumatic hip dislocations (THDs) are severe injuries associated with considerable morbidity. Delayed recognition of fracture dislocations and neurovascular deficits have been proposed to cause deleterious long-term clinical outcomes. Therefore, in this study, we aimed to identify characteristics of epidemiology, injury mechanisms, and associated injuries to identify patients at risk. Methods: For this study based on the TraumaRegister DGU® (January 2002–December 2017), the inclusion criterion was an Injury Severity Score (ISS) ≥9 points. Exclusion criteria were an isolated head injury and early transfer to another hospital. The THD group was compared to a control group without hip dislocation. The ISS and New ISS were used for injury severity and the Abbreviated Injury Scale for associated injuries classification. Univariate and logistic regression analyses were performed. Results: The final study cohort comprised n = 170,934 major trauma patients. We identified 1359 individuals (0.8%) with THD; 12 patients had sustained bilateral hip dislocations. Patients with THD were predominantly male (79.5%, mean age 43 years, mean ISS 22.4 points). Aortic injuries (2.1% vs. 0.9%, p ≤ 0.001) were observed more frequently in the THD group. Among the predictors for THDs were specific injury mechanisms, including motor vehicle accidents (odds ratio (OR) 2.98, 95% confidence interval (CI) 2.57–3.45, p ≤ 0.001), motorcycle accidents (OR 1.99, 95% CI 1.66–2.39, p ≤ 0.001), and suicide attempts (OR 1.36, 95% CI 1.06–1.75, p = 0.016). Despite a lower rate of head injuries and a comparable level of care measured by trauma center admission, both intensive care unit and total hospital stay were prolonged in patients with THD. Conclusions: Since early diagnosis, as well as timely and sufficient treatment, of THDs are of high relevance for long-term outcomes of severely injured individuals, knowledge of patients at risk for this injury pattern is of utmost importance. THDs are frequently related to high-energy mechanisms and associated with severe concomitant injuries in major trauma patients.

Neglected Simultaneous Bilateral Asymmetric Traumatic Hip Dislocation in a Young Male Managed by Closed Reduction Manoeuvres in a Resource-Limited Setting: A Case Report

Neglected Simultaneous Bilateral Asymmetric Traumatic Hip Dislocation in a Young Male Managed by Closed Reduction Manoeuvres in a Resource-Limited Setting: A Case Report

Asymmetrical Bilateral Traumatic Hip Dislocation with Segmental Femur Fracture

Introduction: Hip dislocations are extremely rare, but they are orthopedic emergencies that need to be immediately intervened. Traumatic hip dislocations are usually unilateral and occur toward the posterior region. Bilateral traumatic hip dislocations, on the other hand, are rarer. Asymmetric occurrence of bilateral traumatic hip dislocations is even rarer. The possibility of spontaneous hip dislocation in a healthy person is very unlikely. This is because ligaments wrapping the hip joint make it quite stable. Thus, hip dislocation usually occurs due to a high-energy trauma. Case Report: In this paper we report a unique female patient with asymmetric bilateral traumatic hip dislocation accompanied by a segmental fracture of the femur due to a traffic accident. The patient’s right hip was reduced under sedoanalgesia at the emergency department and the left hip was reduced under anesthesia at operating room. Avascular necrosis did not develop at her 2-year follow-up; however, she has been re-operated after developing nonunion in the left femoral segmental fracture. Conclusion: In conclusion, hip dislocations should be treated in first six hours due to the risk of avascular necrosis. Uncomplicated hip dislocations without accompanied fractures can be treated with sedoanalgesia in emergency service settings. However hip dislocations which are complicated with accompanied fractures should be reduced in operation rooms without delay.

A Novel KMT2D mutation in Kabuki syndrome with elevated liver enzymes and congenital bilateral hip dislocation

Kabuki syndrome (KS) is a rare syndrome that involves defects in a wide range of organs, with each organ showing a different severity of symptoms. Two genes have been associated with patients with KS: lysine (K)-specific demethylase 6A (KDM6A) and lysine (K)-specific methyltransferase 2D (KMT2D). The study reported the case of an 18-month-old Turkish boy diagnosed with KS. The patient showed a typical appearance: widely separated eyes, sparse eyebrows, long palpebral fissures, blue sclera, large prominent ears, and micrognathia. The patient was operated on because of bilateral hip dislocation and undescended testicles. He was also followed up by pediatric gastroenterology with asymptomatic liver enzyme elevation (AST- 79 U/L, ALT -68 U/L, ALP -52 U/L). The whole exome sequencing analysis revealed a novel pathogenic c.13285 C&gt;T (p.Gln4429Ter) mutation in the KMT2D gene. The genotype-phenotype correlation of KS was not precisely established. As per our knowledge, there is limited literature which gives information about the hepato-biliary manifestations of KS. Here, we propose that the new mutation of the KMT2D gene may result in the typical facial features of KS with asymptomatic elevated liver enzymes.

Simultaneous asymmetrical bilateral hip dislocations – A report of three cases with different presentations and management

BackgroundSimultaneous traumatic dislocation of both the hips in an individual is an uncommon injury. It accounts for only 1–2% of all traumatic hip dislocations. Simultaneous traumatic dislocation of both the hips in opposite directions i.e., anterior dislocation of one hip and posterior of the other is even rarer. These asymmetric dislocations need prompt identification for appropriate management. While their management should proceed in a manner commensurate with the accepted management of isolated dislocations to avoid complications, it is the timely identification which is essential. Study detailsRetrospectively the details of three patients with asymmetric bilateral hip dislocations were collected. The article describes the clinical presentation of each patient and the management offered to them. The follow up duration ranged from 15 months to 24 months. ResultsIn the short term, the outcomes in terms of hip pain, movements at the hips and radiological parameters like absence of arthritic or avascular changes were found to be satisfactory in each patient. ConclusionEarly diagnosis and prompt reduction is the essential first step in the appropriate management of these patients to prevent the possible complications. The associated fractures must be managed as per the established principles of trauma care. Long term follow up is essential for identifying if complications like avascular necrosis and secondary osteoarthritis develop after this uncommon injury.

Demographic and Practice Variability Amongst Indian Centres in a Multicentre Prospective Observational Study on Developmental Dysplasia of the Hip.

Since 2017, five Indian centres have enrolled into the International Hip Dysplasia Registry for prospective collection of data on Developmental Dysplasia of Hip (DDH). To assess how baseline patient characteristics and initial treatment modalities differ across these five centres. Registry data collected over 3 years were analyzed. Children with DDH that had radiograph-based diagnoses were included. Collectively, there were 234 hips (181 patients), of which 218 had undergone surgery. Overall, median age at presentation was 25.3months (IQR 16.8-46.0); female/male ratio was 2.6:1 (range 1.46-4.75:1); with 42%, 29%, and 29% unilateral left, bilateral and unilateral right hip dislocations respectively. Most were IHDI grade III and IV dislocations (94%). Closed reduction was performed at all but one centre, at median 15.3months (IQR 9.6-21.1). Open reduction (OR) as a stand-alone procedure was performed at all centres, at median 20.8months (IQR 15.4-24.9). Combination of OR with a single osteotomy, femoral (FO) or acetabular (AO), was performed at all centres at median 29.7months (IQR 22.1-43.5). However, for the same age group, three centres exclusively performed FO, whereas the other two exclusively performed AO. The combination of OR with both FO and AO was used at all centres, at median 53.4months (IQR 42.1-70.8). The preliminary findings of this multi-centre study indicate similar patient demographics and diagnoses, but important differences in treatment regimens across the five Indian centres. Comparison of treatment regimens, using the 'centre' as a predictive variable, should allow us to identify protocols that give superior outcomes.

Outcomes of closed reduction in patients with developmental dysplasia of the hip incorporating open psoas and adductor release and using short leg cast

Background and objectives: Closed reduction and short leg spica casting are the preferred treatment options for children with developmental dysplasia of the hip. This study aimed to show the efficacy behind a standardized closed reduction for managing patients with developmental dysplasia of the hip with concomitant soft tissue releases when indicated and using a short leg plaster of Paris cast to maintain reduction and reporting mid-term results. Methods: A case series of 95 hips in 84 children aged 6-18 months who had closed reduction, with five years follow up or until next operation, involved in this study. The protocol defines acceptable concentric reduction criteria and the indications for an associated soft tissue release. All the patients were immobilized in a short leg cast for three months. Multiple follow-up radiographs were taken to assess Tönnis grade, Severin grade, acetabular index, and osteonecrosis signs. Results: A total of 48 hips were Tönnis grade 3/4 hips. At one year, 15 reductions couldn’t be maintained, and these patients needed open reduction. Of these 15 failed reductions, 7 patients were Severin 1; others were Severin 2. Of the 80 successful closed reductions, 70 hips were Severin 1. Surgical management for residual dysplasia was offered for 8 hips. Osteonecrosis was seen in 23 hips but was transient in 20. Bilateral hip dislocations and most Tönnis 4 hips were more likely to fail. Two children had severe osteonecrosis. Conclusions: Closed reduction, with subsequent adductor and psoas releases, when indicated and using a short leg plaster of Paris cast for three months, brings about good mid-term results in children with developmental dysplasia of the hip aged 6-18 months. Keywords: Developmental dysplasia of the hip, closed hip reduction, open psoas release, short leg cast.

Congenital Insensitivity to Pain and Anhidrosis: A painful experience by a painless child

A three-year-old boy with congenital insensitivity to pain and anhidrosis (CIPA) was first presented with transphyseal separation of distal left humerus. Surgical treatment with closed reduction and k-wiring of transphyseal separation of distal humerus resulted in devastating surgical site infection and osteomyelitis. Multiple surgical debridement and application of external fixator to eliminate infection were futile. At the age of four years, he refused to bear weight as a result of left hip dislocation. Closed reduction and spica cast was unsuccessful, resulting in recurrent left hip dislocation. He has since not been able to walk. At the age of five years, the right hip was dislocated followed by ipsilateral subtrochanteric femur fracture. Appropriate treatments such as hip spica and titanium elastic nail were not possible due to extensive bruising and skin ulceration over the right thigh. This child ended up with a functionless left upper limb, bilateral hip dislocation and malunited right femur fracture. Conservative treatment and watchful neglect might be the ideal treatment for patients with CIPA.