Obturator Dislocation Research Articles

Rare case of a post-traumatic pure obturator dislocation of the hip associated with contralateral femoral neck fracture

Rare case of a post-traumatic pure obturator dislocation of the hip associated with contralateral femoral neck fracture

Obturator dislocation of the hip

Obturator dislocation of the hip is caused by high-velocity accidents as evidenced by its frequent association with other traumatic injuries and, seldom found. Its main complication remains femoral head avascular necrosis. We report on four cases of obturator dislocation of the hip. The mean age of patients was 30 years, and all their injuries followed a road traffic accident. Associated lesions were a contralateral femur fracture in two cases and an osteochondral fracture in one case. Reduction of dislocations was achieved orthopedically under general anaesthesia and the average waiting time before reduction was 20 hours. One patient had an intra-articular incarcerated frag- ment visible on X-ray, and another patient showed signs of early coxarthrosis 15 months later. The average follow-up time was 24 months.

Obturator Dislocation of the Hip in An Athlete: A Rare Injury

Hip Dislocation, particularly the Obturator Variety, is a rare entity, especially in sport settings. It requires reduction within a timeframe of less than 6 hours, performed by a qualified surgeon who is aware of the risk of complications. We report a case of obturator dislocation (anteroinferior) in a 56-year-old patient who is a cycling enthusiast.

Traumatic Obturator Dislocation of the Hip in Adults about a Case and Review of the Literature

It was a 36-year-old patient. He was the victim of a road accident. The clinical examination revealed a deformity of the hip with loss of the anatomical guide. Neurovascular and skin examination were normal. Standard X-ray confirmed obturator dislocation of the right hip. The reduction of the dislocation was carried out under general anesthesia within the time limits, followed by a discharge for 6 weeks. The suites were simple.

Transient inferior over-reduction after open reduction in walking-age DDH: A retrospective analysis of 42 Hips

BackgroundDue to various policy and health infrastructure issues, it is not uncommon to present developmental dysplasia of hip(DDH) at walking-age in India. The purpose of this study was retrospective analysis of operated cases of walking-age DDH with “inferior over-reduction”. Methods“Inferior over-reduction” was defined as break in the Shenton's arc inferiorly in an operated hip which otherwise appears reduced. After Ethical Committee approval, we searched children operated for walking-age DDH. Children suggestive of syndromic association were excluded. We collected demographic data, follow-up, procedures performed, inferior over-reduction and complications. The IHDI grade, Acetabular Index(AI), Smith's ratio for superior (h/b) & lateral displacement(c/b) of femur, and clinical outcome (Modified McKay criteria) were evaluated. The outcomes of cases with inferior over-reduction(Group A) were compared with those without(Group B). Results42 patients with average follow-up of 23 months were enrolled. 21 hips belonged to Group A. By 6 months follow up, all these cases recovered. On comparison of Smith's ratio, group A had significantly higher c/b for the operated hip at 3-month follow-up(p < 0.05). Patients undergoing acetabuloplasty had significantly lower c/b versus all other groups(p < 0.05). Correlation between h/b or c/b with age did not show any significant finding. 15 cases in group A and 14 cases in group B had excellent outcome as per modified McKay's criteria. None of the patients had inferior over-reduction, inferior or obturator dislocation at final follow-up. Three patients with group B had re-dislocation with poor outcome. we recorded 3 hips with AVN (7%). ConclusionsThis study highlights that after OR of walking-age DDH, the inferior over-reduction may be noted in as much as 50% of the cases. However, this is transient, and all cases recover by the 6 months follow up. There is no significant difference between group A & B in functional outcome, AVN rate. Long-term studies are required to see outcome differences between two groups.

Prognostic and therapeutic interest of a new classification in inferior hip dislocation: a systematic review of the literature.

Reported cases of inferior dislocation in the literature are found under several names (inferior, anteroinferior, obturator, or erecta), which may be source of confusion. The purpose of this comprehensive review of the literature is to collect as many cases of inferior dislocation as possible to determine better therapeutic strategies, outcome after reduction, complications, and prognostic factors. In April 2020, a literature search was performed in Pubmed, Medline, Scopus, Cochrane, and Embase databases. The MeSH keywords were "OBTURATOR DISLOCATION HIP" or "ANTERIOR DISLOCATION HIP" or "INFERIOR DISLOCATION HIP." Authors independently selected articles that met the selection criteria, with no time limit. Out of the 97 articles selected, there were 119 cases of primary inferior hip dislocations. This review of the literature has allowed us to differentiate 3 radiographic subtypes of inferior dislocations, which correspond to 3 different anatomical positions of the femoral head: "obturator" dislocation, "proximal anterior-inferior" dislocation, and "distal anterior-inferior" dislocation. Our subtype classification yielded 39 obturator subtype inferior dislocations (32.8%), 66 proximal anteroinferior subtypes (55.4%), and 14 distal anteroinferior (11.8%). The obturator subtype is at risk of reduction failure and femoral neck fracture during the reduction manoeuver. Our study identified 3 subtypes with different prognosis, with obturator and distal anteroinferior dislocations having a poorer prognosis because of their pre- and post-reduction complications. We were unable to determine the correct manoeuver to reduce inferior dislocations without taking the risk of femoral neck fracture, but each of these subtypes may require a different manoeuver.

Traumatic obturator dislocation of the hip: About a case

Traumatic obturator hip dislocation is rare. It accounts for 6 to 10 % of traumatic hip dislocations. It occurs in the context of violent trauma to a hip in a favourable position. Classically, dislocation occurs when the impact is brought to the anteriomedial part of the knee while the hip is in flexion and the limb in abduction and external rotation. The diagnosis is evoked before a hip deformation in flexion abduction external rotation. Confirmation is made by imaging. We report the case of an unhelmeted motorcycle passenger who allegedly fell from his motorcycle and landed on the anteriomedial side of the knee. The pelvic X-ray showed an obturator dislocation of the left hip. Under general anaesthesia, the dislocation was reduced by performing hip flexion associated with axial traction and then internal rotation adduction. The limb was immobilized in a knee brace for 21 days, bearing allowed after 60 days. At 36 months follow-up, the functional and radiological results are satisfactory.

Obturator dislocation of the hip in adults: Two cases

Obturator hip dislocation is a rare variety of hip dislocation in which the femoral head is in front of the obturator foramen. It is caused by a violent accident. Obturator hip dislocation is rarely isolated. It is often associated with acetabular, femoral head or femoral neck fracture. The most feared complication is the femoral head necrosis. That is why an urgent reduction is required. We report two cases of Obturator hip dislocation. The first one is associated with a great trochanter fracture in a 48 years old patient. The second one is an isolated Obturator hip dislocation without any lesion of acetabulum or femoral head or trochanteric mass. In emergency, both had an urgent reduction of the dislocation with general anaesthesia, then transcondylar traction was made. In the first case, the great trochanter fracture has been synthesized by screwed hook plate. The two patient resumed work after three months. At the last review, there was no sign of femoral head necrosis.

Traumatic obturator dislocation of the hip joint: About 2 cases and review of the literature

IntroductionTraumatic dislocation of the hip is a serious lesion, and its obturator variety is rarely reported. It always reflects a high-energy trauma and represents a therapeutic emergency that requires a reduction in less than 6 h due to the risk of aseptic necrosis of the femoral head in the long term.Case reportWe reported 2 cases of hip obturator dislocation in patients aged 21 and 45 years respectively, which occurred following a road accident, received for pain and functional impairment of the hip, and in a typical attitude with hip flexion, abduction, rotation and knee flexion with no downstream limb vascular-nervous injury. The emergency reduction in <6 h, in two cases, followed by functional treatment by offloading for 8 weeks and support of the limb with the resumption of walking had been authorized at 3 months with a return to sport at 16 weeks; made it possible to obtain satisfactory results at 18 months of follow-up, with an absence of a functional gene, stiffness and without signs of necrosis of the femoral head.Discussion and conclusionTraumatic obturator dislocation of the hip constitutes serious lesions and requires early and appropriate management, reduced to closed focus, treated functionally give excellent results in the medium term. The patient must be carefully monitored over the long term and be warned of the risks he runs.

Pure Obturator Dislocation of the Hip, a Rare Variety of Regular Dislocations, and Long-Term Clinical Outcomes

Introduction: Traumatic knee dislocation is considered an orthopedic emergency. Knee dislocations are relatively infrequent injuries. This injury frequently occurs from high-energy impact trauma. Neurovascular injuries can result in debilitating consequences if the diagnosis and treatment are delayed. Associated complications include degenerative arthritis, permanent neurovascular injury, and amputation. The poorest prognosis is seen in patients with knee dislocation longer than 6-8 hours before reduction. History: The 25-year-old male patient presented with a history of a road traffic accident to the emergency department. The patient presented with swelling, pain, and deformity of the left knee and leg. Examination: On examination, the patient had tense swelling and tenderness of the left knee joint and leg. Visible deformity of the left knee joint is seen. The posterior tibial artery and dorsalispedis artery were not palpable. Active ankle and toe movements were absent. Investigations: Plain radiograph was taken at the emergency department of the left knee and leg. X-rays showed anterior dislocation of the knee joint. Treatment: After valid written informed consent, the dislocated left knee joint was reduced under sedation in the operation theatre and immobilized in the above knee plaster slab. Reduction of the knee joint was done within 4 hours of injury. Then the distal pulses were re-assessed. The posterior tibial and dorsalispedis artery was absent. Hence, MR Angiography of the left lower limb was done. It showed popliteal artery transection. So, the artery was explored and end-to-end vascular anastomosis was done. A knee-spanning external fixator was applied to the left lower limb. Fasciotomy was done for the tense leg compartments. After a week, the fasciotomy wounds were infected for which extensive debridement of the wounds was done and antibiotic beads were placed. Knee was mobilized with a gradual range of motion exercises and non-weight bearing mobilization with a foot drop splint. Gradually full weight-bearing ambulation was allowed. Conclusion: Knee dislocation is rare, albeit a serious and potentially limb-threatening condition. The prognosis of knee dislocations is variable and is heavily dependent on the time interval between trauma and initiation of management. Immediate, timely, and proper management can salvage the limb, and amputation is not the only solution. Keywords: Dislocation, Posterior tibial artery, Fasciotomy

Femoral neck fracture combined with anterior dislocation of the femoral head: injury mechanism and proposed novel classification

BackgroundFemoral neck fracture combined with anterior dislocation of the femoral head is very rare. To our knowledge, there is no classification system yet for this rare form of injury, and the injury mechanism of femoral neck fracture combined with obturator head dislocation has not been described in the literature. In this study, we systematically reviewed the literature and the cases treated in our hospital, and identified and classified all injury types according to the injury mechanism of femoral neck fracture combined with anterior dislocation of the femoral head. Further, based on the experience of treating a patient with femoral neck fracture and obturator dislocation of the femoral head, a theoretical hypothesis was proposed for the injury mechanism of this rare type of injury.MethodsA comprehensive search was conducted on PubMed, WOS, CNKI database. These fractures were classified according to the dislocation site and injury mechanism (one injury or two injuries).Results1891 articles were initially identified through PubMed and other databases, and after bibliographic research, study screening, and removing duplicates, 1455 articles were selected. After applying the exclusion criteria, a total of 18 full-text articles describing femoral neck fractures combined with anterior dislocation of the femoral head. Different dislocation sites have different injury mechanisms. Our classification system, to the best of the authors’ knowledge, allowed us to include all types of femoral neck fractures combined with anterior dislocation of the femoral head from the literature. According to the proposed classification system, the morphological features of femoral neck fracture combined with anterior dislocation of the femoral head can be accurately conveyed between doctors.ConclusionsAll injury patterns can likely be identified using the proposed classification system. This can help avoid confusion in the nomenclature of femoral neck fractures combined with anterior dislocation of the femoral head and help surgeons to more accurately detect lesions, thereby guiding surgical treatment.

Anterior Hip Dislocation: Characterization of a Rare Injury and Predictors of Functional Outcome

BackgroundAnterior native hip dislocation remains poorly studied due to the rarity of the injury. The aim of this study was to describe injury characteristics of anterior hip dislocation, detail its initial treatment, and determine the intermediate term outcomes including the rate of conversion to total hip arthroplasty (THA). MethodsA cross-sectional study was performed at a single urban academic Level 1 trauma center for patients who sustained traumatic anterior hip dislocations from 2010-2017. Baseline demographic, injury, and treatment data were recorded. Patients were contacted to inquire about subsequent surgery and complete functional outcome questionnaires. Available post-operative radiographs were also reviewed. ResultsThirty-two anterior hip dislocations met inclusion criteria and were included in the study. 69% of dislocations were obturator dislocations and 31% iliac dislocations. Only 22% were simple dislocations with the remainder having an associated femoral head fracture and/or acetabular fracture. Iliac dislocations were more likely to be associated with acetabular fractures and require surgical treatment while obturator dislocations were more likely to be simple dislocations or have femoral head fractures. Excluding two patients treated with acute THA at the time of injury, follow-up information was available for 16 patients at a minimum of eighteen months from the time of injury. Only one required subsequent conversion to THA. For the remaining fifteen patients, modified Harris hip scores (mHHS) averaged 82.6, PROMIS global physical health averaged 51.9, and PROMIS global mental health averaged 48.3 with mean follow-up of 4.2 years. mHHS was significantly higher for obturator dislocations and a negative association was seen with age. ConclusionsObturator dislocations occurred twice as frequently as iliac dislocations. Associated acetabular or femoral head fractures are common. Conversion to THA was low, occurring in only 1 of 16 patients not treated with acute arthroplasty. Obturator dislocations and age less than 45 years old at the time of injury were associated with better functional outcome at intermediate term follow-up.

Luxación anterior obturatriz traumática de cadera en la edad pediátrica

Hip dislocation of the anterior – obturator type is an unusual pathology in pediatric orthopedics, but with potentially serious complications in evolution. By the way, we present the case of a 14-year-old girl who suffered a secondary anterior – obturator dislocation and high-energy trauma. A closed reduction was made in the surgical block under general anesthesia, with good evolution and without complications in a follow-up of 24 months.

Obturator dislocation of the hip with ipsilateral femoral neck fracture: A case report

Obturator dislocation of the hip with ipsilateral femoral neck fracture: A case report

Traumatic Obturator Dislocation of the Hip Joint with Fracture of the Femoral Head: A Case Report and Review of the Literature

Traumatic Obturator Dislocation of the Hip Joint with Fracture of the Femoral Head: A Case Report and Review of the Literature

Luxation obturatrice de la hanche : survenue rare en milieu sportif

Obturator dislocation of the hip joint is a rare entity, especially in the sport setting. Treatment require reduction in less than six hours performed by a qualified surgeon. There is an important risk of complications. We report a case of antero-inferior obturator dislocation in a 56-year-old man who had a cycling injury.

Post - Traumatic Hip with Obtu rator Dislocation: Case Report a nd Review of t he Literature

Introduction: Traumatic dislocation of the coxofemoral joint is defined as the permanent posterior or anterior displacement of the femoral head out of the acetabular cavity. It is generally the consequence of a violent trauma, most often an accident on the public road. o ur case it is a post - traumatic hip obtu rator dislocation, managed in our department. Clinical case and results: 16 years old patient, with no particular history, victim of a road accident, causing a closed trauma to his left hip, right ankle and left wrist. It presents with a vicious attitude: left lower limb in flexion, abductio n, external rotation. An X - ray reques ted objective obturator dislocation with a small bone fragment of the head. A bone reconstruction CT was completed in favour of obturator dislocation with head fracture type 1 according to Pipkin's classification. Patient sent directly to the block, he ben efits from a reduction under sedation according to Boehler's maneuver, control by scopy, then immoblisation by zimmer splint after testing the stability of dislocation. Patient is hospitalized in our ward for monitoring then follow - up in consultation. Resu lts were satisfactory, removal of the zimmer splint at the 6th week. Total support was possible at week 12, with complete mobility, patient reviewed afterworld without clinico - radiological signs of aseptic necrosis of the femoral - head. Conclusion: The frac ture - luxation of the femoral head is a serious lesion. It is necessary to think about it in front of each dislocation not to ignore the associated fracture which still darkens the prognosis.

Use of the HemiCAP partial hip resurfacing technique for traumatic femoral head osteochondral defects following obturator hip dislocations.

Fracture of the femoral head (OTA 31-C1.3) following anterior obturator dislocations are a challenging problem as the fractures are often communited, impacted and with loose osteochondral fragments, making surgical fixation difficult. This can result in residual articular defects if the fragments cannot be internally fixed and need be excised, predisposing to secondary osteoarthritis. Treatment options for these defects are limited, have variable results and with limited literature to guide us on outcomes due to the rarity of these injuries. Here, we describe the first use of the technique of partial femoral head resurfacing in two patients with such fractures and report on their long term outcomes.

A Bilateral Traumatic Hip Obturator Dislocation.

A case of a bilateral simultaneous traumatic obturator dislocation of both hip joints in an 18-year-old young man following a traffic accident is presented. We reduced the dislocated femoral heads immediately under general anesthesia followed by passive and active exercises and early full-weight bearing mobilization. After 5 years, the result was excellent.

Arthroscopic and imaging findings after traumatic hip dislocation in patients younger than 25 years of age

The aim of this study is to identify intra-articular pathology and loose bodies during arthroscopic examination of young patients after hip dislocation and to correlate arthroscopic findings with preoperative imaging. Twelve hips in 12 patients (eight males, four females; mean age 16.3 years, range 11–25 years) underwent hip arthroscopy after traumatic hip dislocation. Medical records, imaging studies and intra-operative images were reviewed to determine the damage to the hip joint, acetabular morphology, including labral and/or cartilage injury and presence of loose bodies. Imaging findings were compared with arthroscopic findings and treatment. All 12 patients underwent arthroscopy, which was performed an average of 59 (range 1–359, median 17.5) days after dislocation. Ten patients had posterior hip dislocations and two patients had obturator dislocations. All patients underwent closed reduction as initial management, with one incongruent reduction. Eleven patients had computed tomography scans and four patients had magnetic resonance imaging (MRI) with three patients having both modalities. Loose bodies were identified in 6/12 (50%) patients on pre-operative imaging and in 8/12 (67%) patients at arthroscopy. The two patients with unidentified loose bodies on imaging did not have a preoperative MRI. Five patients had acetabular cartilage injuries and three patients had femoral-sided cartilage injuries. Eight patients had labral injuries at arthroscopy. Intra-articular injuries and loose bodies are common in adolescent and young adult patients undergoing arthroscopy following traumatic hip dislocation. Further studies are needed to determine whether arthroscopy after traumatic dislocation may play a role in hip preservation following these injuries.