Close Reduction Research Articles

Comparative study of cast immobilization of wrist in functional position versus conventional palmar flexion in Colles’ fracture

Background: Colles’ fracture is a common injury in the elderly population. Although it can be easily reduced, it is difficult to maintain the reduction in the conventional position of the wrist in palmar flexion with a poor functional outcome. Thus our study aimed to compare the radiological and functional outcome of such fractures with the wrist in two different posi­tions of dorsiflexion and palmar flexion.
 Methods: A prospective, observational study was conducted from April 2019 to March 2020 in the Orthopedics and Emergency department of KIST Medical College Teaching Hospital, Lalitpur, Ne­pal. Sixty-two patients, 31 in each group, all above 45 years with Colles’ fracture underwent close reduction and below elbow cast immobilization under hematoma block. Maintaining palmar flex­ion and ulnar deviation at the fracture site, the wrist was immobilized in dorsiflexion and palmar flexion attitude alternatively. During the respective follow-ups, the Demerit Scoring System of Saito was evaluated. Data collection and entry was done using the statistical package for social science version 16 and analyzed by using descriptive and inferential statistics.
 Results: All fractures were united. At the end of twelve weeks, Saito Scoring System of good to ex­cellent was markedly better in dorsiflexed group 29(93.5%) patients as compared to palmar flexed group 22(71.0%) patients, similarly grip power was also superior in dorsiflexed group 19(61.3%) patients than in palmar flexed group 11(35.5%) patients.
 Conclusions: Cast immobilization of Colles’ fracture with the wrist in dorsiflexion prevents re-dis­placement of the fragments resulting in significantly better radiological and functional outcomes.

Pediatric Radial Neck Fractures: Which Ones Can Be Successfully Closed Reduced in the Emergency Department?

The purpose of this study is to examine pediatric patients with a radial neck fracture and determine the factors associated with a failed closed reduction (CR) in the emergency department (ED). A total of 70 patients with acute radial neck fractures were retrospectively reviewed. Inclusion criteria were: age 18 years or younger at time of injury, diagnosis of radial neck fracture without other associated elbow fractures, an attempt at CR with manipulation in the ED or immediate surgery, open proximal radial physis, and appropriate imaging to categorize the injury. Charts were reviewed and demographic data was obtained. Initial injury films were reviewed and the Judet classification was used to define fracture types/categories. CR was attempted on 41 patients. Twenty-nine patients went straight to surgery without a CR attempt. Compared with patients that had an attempted CR in the ED, patients that went straight to surgery had longer mean time from injury to ED presentation (5.6 d; P=0.0001), greater mean fracture angulation (55.0 degrees; P=0.001), and greater fracture translation (46.2%; P=0.001). When analyzing the patients that had a CR attempted in the ED, univariate statistical analysis demonstrated that ≥Judet 4 classification (P=0.03), greater amounts of fracture angulation (P=0.003), and a treatment delayed >24 hours from injury (P=0.007) were significant risk factors for failure of CR in the ED. Zero (0/10) patients with fracture angulation ≥60 degrees had a successful CR. Only 1/14 patients presenting >24 hours after injury had a successful CR in the ED. Circumventing sedation in the ED, and instead splinting for a planned surgical intervention may be a more efficient treatment method for pediatric radial neck fractures that present to the ED>24 hours after injury and/or have angulations ≥60 degrees. Adopting this new strategy may save time, reduce costs, and avoid possible harm/complications associated with sedation in the ED. Level III-prognostic.

Comparison of Open Vs Closed Reduction of Mandibular Angle Fractures-A Retrospective Institutional based Study

Fractures of the mandible, particularly in the angle region have been found to have a high incidence.Clinical and radiographic examination along with the basis of displacement help to decide the treatmentmodality for these fractures. Open reduction is generally performed when there is significant deviation andclosed reduction for simple fractures. The most common modality being Open Reduction with InternalFixation(ORIF). The aim of the study is to compare Open Vs closed reduction in patients with fracture in theangle region of the mandible. This retrospective study involved a sample size of 18 patients with mandiblefracture in the angle region. Case records were collected, tabulated and imported to SPSS for statisticalanalysis. Descriptive statistics and chi-square tests were adopted for association of various parameters.Angle fractures were most commonly seen in males(89%) than females. RTA and assault were the mostcommon reason for trauma caused - 39% & 33% respectively. 89% of the treatment done was through openreduction with majority being treated by internal fixation(94%). Angle fracture management depends uponthe severity of the displacement to decide the method of reduction and type of stabilisation. Open reductionwith internal fixation was the most common treatment adopted in this study .

A Study on Designing, Development and Testing of an Innovative External Jig for the Percutaneous Screw Fixation of the Acetabular Column Fractures

Background: Operative treatment of acetabulum fractures often requires open surgical fixation. Minimallyinvasive surgery (MIS) with percutaneous screw fixation can be done is some acetabular column fractureswhich are amenable to closed reduction. This can be done free hand using intraoperative fluoroscopy or withthe help of advanced 3D navigation system. Free hand technique exposes the operative staff to considerableintraoperative fluoroscopy,has a steep learning curve and there is a risk of screw malpositioning. Eventhough 3D navigation is highly accurate, the affordability of the navigation system in a rural set up is notfeasible. Use of an external universal modular jig which has been routinely used for the fixation of longbone fracture, can give similar results in the fixation of undisplaced/minimally displaced acetabular columnfractures amenable to close reduction. Currently such jigs are not available for the management of acetabularfractures.Objectives: With this study we aim to design a modular jig for the percutaneous fixation of the acetabularcolumn fracture fixation. Also we will validate in vitro efficacy and safety on cadaveric models. To test theclinical efficacy on minimally displaced acetabular column fractures.Methodology: It will be an observational study conducted at the Department of Orthopaedics, JNMC,Sawangi and Wardha, India. A 3 D model of the pelvis will be made based on the CT scan data of 40patients using Mimics 10.01 software (Materialize, Leuven, Belgium) software. After the desired jig ismade,its accuracy will be checked on the saw bone and cadaveric model. Once the accuracy of the jig hasbeen established, it will be used on the suitable patient population and the results will be compared withthe matched patient population who have been operated using the traditional free hand technique underfluoroscopy control.Results: The results will be compared based on the operating time,radiation exposure,hospital stay andpostoperative outcome. During follow up,patients in both the groups will be evaluated clinically with Harris hip score (HHS) and radiologically withMatta outcome grading. To evaluate functionaloutcome patients the patients will be categorizedinto excellent (HHS, 90-100), good (HHS, 80-90), fair (HHS, 70-80) and poor (HHS, <70).Conclusion: This study will help in designing and development of an universal external modular jig for theMIS and percutaneous fixation of acetabular column fracture.

Poor delineation of labrum and acetabular surface on arthrogram is a predictor of early failure of closed reduction in children aged six to 24 months with developmental dysplasia of the hip.

PurposeThe objective of this study was to explore the predictors for failed reduction in children with developmental dysplasia of the hip (DDH) managed by arthrogram, closed reduction (CR) and spica cast immobilization.MethodsWe retrospectively reviewed the clinical data of patients with DDH treated by CR and cast immobilization (2015-2020), including age, sex, affected side, presence/absence of an ossific nucleus, International Hip Dysplasia Institute classification, the delineation of labrum and acetabular surface on arthrogram, inverted labrum, acetabular index (AI), hip abduction angle and medial dye pool (MDP) distance. Predictors that potentially predicted failure of CR were evaluated by logistic regression analysis, simple t-test, Fisher’s Exact Test and chi-square test.ResultsIn total, 16 out of 187 hips failed to achieve initial CR (8.6%). Gender, age, preoperative AI and poor delineation of arthrogram were candidate predictors for failed CR in children aged six to 24 months with DDH; on the other hand, logistic regression analysis confirmed age and poor delineation of arthrogram significantly predicted failure of CR. Receive operating characteristic curve (ROC) showed MDP less than 6 mm and age higher than 14.5 months significantly increased the failure rate of CR in children aged six to 24 months with DDH.ConclusionAge and poor delineation of labrum and acetabular surface during arthrogram predicted failure of CR in children with DDH. In particular, age > 14.5 months and MDP distance ≥ 6 mm significantly increased the risk of CR failure.Level of evidenceIII

COMPARATIVE STUDY OF CAST IMMOBILIZATION OF WRIST IN FUNCTIONAL POSITION VERSUS CONVENTIONAL PALMAR FLEXION IN COLLES’ FRACTURE

Background: Colles’ fracture is a common injury in the elderly population. Although it can be easily reduced, it is difficult to maintain the reduction in the conventional position of the wrist in palmar flexion with a poor functional outcome. Thus our study aimed to compare the radiological and functional outcome of such fractures with the wrist in two different posi­tions of dorsiflexion and palmar flexion. Methods: A prospective, observational study was conducted from April 2019 to March 2020 in the Orthopedics and Emergency department of KIST Medical College Teaching Hospital, Lalitpur, Ne­pal. Sixty-two patients, 31 in each group, all above 45 years with Colles’ fracture underwent close reduction and below elbow cast immobilization under hematoma block. Maintaining palmar flex­ion and ulnar deviation at the fracture site, the wrist was immobilized in dorsiflexion and palmar flexion attitude alternatively. During the respective follow-ups, the Demerit Scoring System of Saito was evaluated. Data collection and entry was done using the statistical package for social science version 16 and analyzed by using descriptive and inferential statistics. Results: All fractures were united. At the end of twelve weeks, Saito Scoring System of good to ex­cellent was markedly better in dorsiflexed group 29(93.5%) patients as compared to palmar flexed group 22(71.0%) patients, similarly grip power was also superior in dorsiflexed group 19(61.3%) patients than in palmar flexed group 11(35.5%) patients. Conclusions: Cast immobilization of Colles’ fracture with the wrist in dorsiflexion prevents re-dis­placement of the fragments resulting in significantly better radiological and functional outcomes.

Timing for closed reduction procedure for developmental dysplasia of the hip and its failure analysis

BackgroundIt remains controversial whether the older age to perform closed reduction (CR) procedure for developmental dysplasia of the hip (DDH), the higher incidence of complications. The aim of this study is to evaluate the midterm outcome of CR for DDH among different age groups, and to analyze and identify risk factors for the failure of this procedure.MethodsClinical data of 107 DDH patients, who received CR, were retrospectively reviewed. Data were divided into three groups according to initial treatment age (Group I: younger than 12 months; Group II: 12 months to less or equal to18 months; Group III: older than 18 months). The presence of avascular necrosis (AVN), residual acetabular dysplasia (RAD), re-dislocation, and further surgeries (FS) were observed. The risk factors were identified for those outcomes aforementioned using univariable logistic regression models. For identified risk factor age, pre-op acetabular index (AI) and post-op AI, their prediction of CR failure were evaluated by receiver operating characteristics curve (ROC).ResultsA total of 107 patients (156 hips) undergoing CR procedure were evaluated with a median age at initial reduction of 13.0 ± 5.4 months (range, 4 to 28 mo). Mean follow-up time in this study was 6.7 ± 0.8 years (range, 3–8 years). The incidence of AVN, RAD and re-dislocation was 15.4% (24/156), 17.3% (27/156) and 14.7% (23/156) respectively. For AVN, RAD and re-dislocation, the significant risk factors are pre-op IHDI IV (p = 0.033), age ≥ 18 months (p = 0.012), and pre-op IHDI IV (p = 0.004) and walking (p = 0.011), respectively. The areas under the ROC curve of each type of failures were 0.841 (post-op AI), 0.688 (pre-op AI) and 0.650 (age).ConclusionsSevere DDH patients older than 18 months with CR procedure may result in a high risk of RAD complication. Re-dislocation is significantly associated with pre-op IHDI IV and walking. Patients, who are older than 12.5 months or have a pre-op AI of 38.7° or a post-op AI of 26.4°, are also more likely to fail of CR procedure.

Contact pressure distribution of the hip joint during closed reduction of developmental dysplasia of the hip: a patient-specific finite element analysis

BackgroundDevelopmental dysplasia of the hip (DDH) is the most common deformity of the lower extremity in children. The biomechanical change during closed reduction (CR) focused on cartilage contact pressure (CCP) has not been studied. Thereby, we try to provide insight into biomechanical factors potentially responsible for the success of CR treatment sand complications by using finite element analysis (FEA) for the first time.MethodsFinite element models of one patient with DDH were established based on the data of MRI scan on which cartilage contact pressure was measured. During CR, CCP between the femoral head and acetabulum in different abduction and flexion angles were tested to estimate the efficacy and potential risk factors of avascular necrosis (AVN) following CR.ResultsA 3D reconstruction by the FEA method was performed on a 16 months of age girl with DDH on the right side. The acetabulum of the involved side showed a long, narrow, and “flat-shaped” deformity, whereas the femoral head was smaller and irregular compared with the contralateral side. With increased abduction angle, the stress of the posterior acetabulum increased significantly, and the stress on the lateral part of the femoral head increased as well. The changes of CCP in the superior acetabulum were not apparent during CR. There were no detectable differences in terms of pressure on the femoral head.ConclusionsSevere dislocation (IHDI grade III and IV) in children showed a high mismatch between the femoral head and acetabulum. Increased abduction angle corresponded with high contact pressure, which might relate to AVN, whereas increased flexion angle was not. Enhanced pressure on the lateral part of the femoral head might increase the risk of AVN.

Clinical and epidemiological features of tibial tubercle avulsion fracture in Chinese adolescents

BackgroundTibial tubercle avulsion fracture is rare in children. Accumulated knowledge on clinical and epidemiological features of this fracture is of practical significance for clinical colleagues to deal effectively with such...

Factors affecting early re-displacement of paediatric diaphyseal forearm fractures at Korle Bu Teaching Hospital.

Complete fractures of the forearm have the potential to displace and angulate with overriding fracture fragments. Maintaining acceptable reduction is not always possible, and re- displacement or re-angulation is the most commonly reported complication. Factors responsible for the re-displacement after an initial acceptable reduction have not been clearly defined. The study aimed to determine the factors that influence early re-displacement of paediatric diaphyseal forearm fractures in Korle-Bu Teaching Hospital. A prospective study in a cohort of 72 children below the age of 12 years with diaphyseal forearm fracture attending the Orthopaedic clinic were followed with close reduction casting from April 2017-December, 2017. Factors analysed included demographics, initial fracture features and the radiographic indices of the cast quality. 93.1% (67) of the fractures were because of the children falling on an outstretched arm. Majority of the children had a fracture of the distal 1/3 of the radius (n=38, 52.6%). The overall C.I was 0.8 (SD 0.1). The only significant predictor for predicting re-displacement was children falling on an outstretched hand (p-value=0.0). This study has shown that the degree of initial displacement and the ability to achieve good reduction with a well moulded cast, constitute the major factors for early re-displacement of paediatric forearm fractures. Personal funding.

Acute Total Hip Arthroplasty for the Treatment of Acetabular Fractures: A Retrospective Study With a Six-Year Follow-Up

ObjectivesWhile open reduction and internal fixation is considered the gold standard for the treatment of acetabular fractures, it is associated with significant complications due to prolonged immobilization for elderly patients. The aim of this study was to investigate the clinical and radiological outcomes in elderly patients treated with an acute total hip arthroplasty (THA).Patients and methodsThis retrospective study included 16 patients (10 women and 6 men) with a mean age of 80.1 years suffering from a displaced acetabular fracture after a low-energy trauma. Primary THA was performed in all cases, by the same surgeon, within a three-week period after the fracture. The Burch-Schneider reinforcement ring with a cemented cup was used in 10 patients and a jumbo acetabular cup was used in 6 patients, whereas autologous bone graft was used in all cases.ResultsWith a mean follow-up of 72 months, one dislocation occurred that was treated with close reduction, and one patient developed superficial site infection that was managed conservatively with antibiotics. No periprosthetic fractures, deep infections, or other adverse events were observed. One case of asymptomatic radiographic loosening was reported and treated conservatively. And autologous bone graft was well incorporated. Clinical scores were significantly improved, and all patients were able to walk independently.ConclusionsAcute THA for the treatment of displaced acetabular fractures in elderly patients seems to be a safe option with good functional and radiological outcomes and low complication rates, offering early mobilization and weight-bearing ability to elderly patients.

Long term outcome of ipsilateral dislocation of open displaced elbow with close shoulder dislocation: a case report

52 years old man presented with open dislocation of elbow due to road traffic accident was not complaining of another joint injury or pain was radiographed as per protocol of including the adjacent shoulder joint and incidentally discovered with anterior dislocation of shoulder was treated with close reduction of shoulder dislocation and debridement as well as reduction and trans fixation of ulno-humeral joint with k-wires. Skin coverage later was done. Patient recovery was excellent in terms of motion at both joints. The purpose of reporting of this case is to convey a message that ipsilateral dislocation of shoulder and elbow is a very rare occurrence but do occur and a high degree of suspicion and imaging protocol can save from missing this event.

Comparison of Outcome of Close Reduction Versus Open Reduction in Treatment of Comminuted Mandibular Fracture

Comparison of Outcome of Close Reduction Versus Open Reduction in Treatment of Comminuted Mandibular Fracture

A Prospective Randomized Trial Comparing the Functional Results of Buddy Taping Versus Closed Reduction and Cast Immobilization in Patients With Fifth Metacarpal Neck Fractures

Although fifth metacarpal neck fractures are typically treated nonsurgically, most often with closed reduction and orthosis immobilization, cast immobilization may not improve outcomes compared with buddy taping without reduction. The aim of this study was to compare functional outcomes of buddytaping versus reduction and cast immobilization in patients with fifth metacarpal neck fractures. Adult patients with acute fifth metacarpal neck fractures with less than 70º volar angulation and without rotational deformity were randomly assigned to be treated either with buddy taping or a cast after closed reduction. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score at 9 weeks. Secondary outcomes included the DASH score at 3 weeks and 1 year, range of motion of the metacarpophalangeal joint, pain, grip strength, return to work, radiographic angulation, and complication rate. We recruited 72 patients between August 2016 and January 2018. After 3 weeks, the DASH score was significantly lower for patients treated with buddy taping (19.7 ± 19.7) compared with cast immobilization (44.6 ± 15.0). At 9 weeks, clinical outcomes in the buddy taping group were better in terms of range of motion and DASH score, with a mean difference of 6.3 points, which did not exceed the minimally clinically important difference. There were more complications in the cast immobilization group. Fracture angulation after reduction was followed by a loss of reduction at 3 weeks' follow-up and equivalent residual radiographic volar angulation was observed at 3 and 9 weeks after injury in both groups. Duration of time off from work was 28 days shorter with buddy taping compared with cast treatment. There is no benefit to reduction and orthosis immobilization of fifth metacarpal neck fractures with an initial angulation less than 70°. Use of buddy taping and early mobilization had good clinical results as well as significant improvement in time lost from work. Therapeutic I.

Carbon dioxide emissions estimation of conventional diesel buses electrification: A well-to-well analysis in Shenzhen, China

Electrification of public transit bus has been rapidly promoted to reduce carbon dioxide (CO2) emissions in China. It is essential to evaluate the impacts of battery electric buses (BEBs) adoption on real-world CO2 emissions. This paper conducted a well-to-well (WTW) analysis to estimate the CO2 emissions of BEBs in Shenzhen. First, we identified the regional inventory from an extensive review of research papers and data. Based on the mobile BEBs data, we explored the impacts of different driving conditions on WTW CO2 emissions. Moreover, a sensitivity analysis was performed to assess the reliability of the WTW results. The experiments results show that BEBs can reduce WTW CO2 emission by 21.8% relative to conventional diesel buses (CDBs) in 2018. And the WTW CO2 emissions factor of BEBs has a negative correlation with stop headway and average speed. Notably, the impacts of CO2 emissions reduction are more sensitive when the stop headway is over 2 km or the average speed is under 25 km/h. Besides, for the current power structure and charging technology in Guangdong, if the growths of the thermal power share and the charging loss are over 5%, BEB has more CO2 emissions reduction benefits by improving the charging efficiency. Moreover, if the thermal power share and the charging loss are decreased, BEB can obtain more CO2 emissions reduction potential by reducing the thermal share. The improvement of these two technologies can achieve close CO2 emission reduction effects in other situations.

A Plate Lines Up the Bone Better, But That Doesn't Seem to Matter Much: Commentary on an article by Andrew R. Stephens, BS, et al.: "Volar Locked Plating Versus Closed Reduction and Casting for Acute, Displaced Distal Radial Fractures in the Elderly. A Systematic Review and Meta-Analysis of Randomized Controlled Trials".

A Plate Lines Up the Bone Better, But That Doesn't Seem to Matter Much: Commentary on an article by Andrew R. Stephens, BS, et al.: "Volar Locked Plating Versus Closed Reduction and Casting for Acute, Displaced Distal Radial Fractures in the Elderly. A Systematic Review and Meta-Analysis of Randomized Controlled Trials".

Close Reduction Technique for Severely Displaced Radial Neck Fractures in Children.

Radial neck fractures account for 5-10% of paediatric elbow trauma. Radial neck fractures have been classified by Judet into five types (I-IVb). There is a global agreement to reduce radial neck fractures with angulation more than 30° (Type III, IVa and IVb). Various maneuvers have been described but none of them uniformly achieved complete reduction in severely displaced radial neck fractures (Type IVa and Type IVb Judet). In this case series, we are presenting our experience with close reduction of ten severely displaced paediatric radial neck fractures to achieve complete anatomical reduction. We attempted close reduction in ten consecutive children with average age of 8.59 ± 1.68years (range, 6-12years) who presented with severely displaced radial neck fracture (Type IVa and IVb Judet). There were five girls. All patients had close injuries and presented to us within 24-48h. One of the patients had associated undisplaced lateral condyle fracture. We have excluded two patients with associated elbow dislocation. Close reduction was performed within 48h of initial injury. We were able to obtain complete anatomical reduction in all of our patients with this technique. None of the patients required fixation of fracture. At 1year of follow-up, (12 ± 2.07months, range 9-16months) all patients demonstrated almost full range of elbow and forearm motion. Final radiographs revealed complete union without any evidence of avascular necrosis. This technique offers an option of close reduction for the most severely displaced radial neck fractures, which were otherwise being treated by surgical intervention. The online version of this article (10.1007/s43465-020-00168-6) contains supplementary material, which is available to authorized users.

Surgical challenges of down syndrome with developmental dislocation or dysplasia of the hip undergo operative treatment under anaesthesia in teaching hospital

&lt;p&gt;Developmental/dislocation of the hip is one of the orthopaedic issues and the most common problem of the hip in down syndrome (DS). Down syndrome often arises with its general laxity problematics, one of the things is developmental dislocation/dysplasia of the hip (DDH). In chronic cases, surgery is a must, and this is mentions in several journals. Some complications can occur in the process of anaesthesia with intubation. We report two cases, both of which are seven years old with patients in the first case experiencing DDH and patients in the second case experiencing dislocation. The first patient had open reduction surgery with capsulotomy and internal fixation. The second patient, close reduction, and hemi spica installation. The first patient has trouble breathing one week after surgery, and then the tracheotomy is performed. A tracheotomy performed for almost two months and hemi spica removed in September 2019. After hemi spica removal, the patients were then routinely controlled for rehabilitation polyclinics, and the results improved.&lt;/p&gt;

Supracondylar fracture humerus (Gartland Type III) managed with closed reduction and percutaneous pinning (CRPP) in children.

Objectives: The objective of this study is to assess the functional outcome of close reduction and percutaneous K- wire fixation in supracondylar humeral fracture (SCHF) Gartland type III fractures in children. Study Design: Experimental study. Period: January 2017 to December 2017. Setting: Department of Orthopedics Civil Hospital Karachi. Material &amp; methods: 60 children sustaining a Gartland type III supracondylar humerus fractures less than 1 week old that was treated by closed reduction and percutaneous pinning. Clinical results were evaluated using the Flynn’s criteria. Results: All the 60 children with Gartland type III supracondylar humerus fracture included in this study. 42 (70%) boys and 18 (30%) girls with age ranging between 2 to 10 years .Right side was involved in 37(62%) and left side was involved in 23 (38%) patients. All patients are of extension type fracture. According to Flynn’s criteria cosmetic results were excellent in 54 (90%) and good in 6 (10%) patients and functional results were excellent in 54 (90%), good in 4(7%), fair in 2 (2%) and poor in 1(1%) patient. One patient ulnar nerve injury, after 3 months nerve explored that was contused, symptoms resolved afterwards. Conclusion: Close reduction and percutaneous fixation with K-wire in Gartland III fracture in children is safe and effective treatment method with minimal hospital stay and less complications.

Traumatic asymmetrical bilateral hip dislocation: A case report

Traumatic asymmetric bilateral hip dislocations, with one hip dislocated posteriorly and the contralateral hip dislocated anteriorly, are a rare injury pattern. It represents approximately 0.01% to 0.02% of all hip dislocations. The most common mechanism of injury is motor vehicle accident. Herein, we report a case of traumatic asymmetric bilateral hip dislocation caused by high energy accident. The patient suffers from a hit to his lumbosacral area by a falling tree weight approximately 200 kg from behind. Pelvic X-ray revealed anterior-inferior dislocation of right hip, posterior fracture dislocation of left hip, and right tibia-fibula fracture. He received emergent close reduction followed by open reduction and internal fixation of left hip posterior acetabulum wall fracture and right tibia-fibula fracture. Union of fracture noted 4 months after surgery and the patient ambulates well with no walking aid. No definite osteonecrosis or arthrosis was found during the 2-year follow-up.