Posterior Hip Dislocation Research Articles

New reduction technique for posterior prosthetic hip dislocation: a case report demonstrating ease of reduction with this technique in larger patients

The authors describe a new technique for posterior prosthetic hip dislocation. This technique is unique because it requires only one assistant and is suitable for smaller physicians who are performing the reduction on much larger patients. This technique uses the first-order lever created by the knee and extensor mechanism, which acts as a fulcrum, to convert the applied force necessary to perform the reduction from a pulling force into a pushing force. This case report presents an obese patient with a posterior prosthetic hip dislocation that was reduced with this new technique after two failed attempts with conventional methods.

Failed reduction of posterior hip dislocation accompanied by femoral head fracture: causes and resolving strategy.

We investigated the causes of failure of the Allis manoeuvre for posterior hip dislocations with an associated Pipkin type I femoral head fractures. The effectiveness of a modified Allis manoeuvre was also evaluated. From January 2013 to December 2016, we enrolled five patients with a posterior hip dislocation associated by a Pipkin type I femoral head fracture who were treated initially with the Allis manoeuvre that subsequently failed. Radiographic evaluations were performed to determine the cause of failure, and then a modified Allis manoeuvre was performed. During this procedure, the hip and knee joints of the injured lower limb were both flexed to 90°, and the leg was pulled posteriorly following an upward force to reduce the dislocation. Reduction was assessed by radiographic evaluation. In all patients, the fractured femoral head was incarcerated on the superior edge of the posterior rim of the acetabulum, resulting in failure of the conventional Allis manoeuvre. Satisfactory reduction was achieved with a modified Allis manoeuvre. The mean follow-up duration was 31months. The femoral head fracture healed after four months on average. The mean Harris score was 91 at the final follow-up. Re-dislocation or femoral head necrosis was not observed. For posterior hip dislocations associated with a Pipkin type I femoral head fracture, failed reduction is often caused by incarceration of the fractured femoral head on the superior edge of the posterior rim of the acetabulum. The modified Allis manoeuvre can effectively reduce the combined injury in a closed fashion.

Total Hip Arthroplasty in Adolescents and Young Adults for Management of Advanced Corticosteroid-Induced Osteonecrosis Secondary to Treatment for Hematologic Malignancies

BackgroundOsteonecrosis of the femoral head (ONFH) is a potentially severe toxicity associated with glucocorticoid treatment for pediatric hematologic malignancy. We examined clinical outcomes of THA in adolescents and young adults treated for hematologic malignancies who developed advanced ONFH. MethodsIn a single-institution cohort, we retrospectively reviewed medical records and imaging for perioperative complications, reoperations, functional assessment at last follow-up, and radiological outcomes. Twenty-seven patients (41 hips) underwent THA (bilateral in 14 patients). There were 11 males. Median (interquartile range [IQR]) age at primary diagnosis was 14.9 years [1.8-18.9]. The median (IQR) age at THA was 19.8 years [14.6-30.3]. Mean (range) post-THA follow-up was 111.5 months (65.4-165.8). ResultsPerioperative complications included one intraoperative calcar fracture that was secured with a cerclage wire and one posterior hip dislocation that occurred 6 days postoperatively, requiring closed reduction. One hip required a revision 21.1 months post-THA due to a fractured ceramic liner. The radiographic review was available for 38 of 41 hips and demonstrated none with loosening, subsidence, or osteolysis; nine developed periacetabular stress shielding. Incidence of stress shielding was associated with increased postoperative pain (P = .0130). There was a significant functional improvement in range of motion (ROM), pain, use of supports, participation in school, work, and sports, and use of pain medication from preoperative to postoperative clinical visits (P < .001). DiscussionTotal hip arthroplasty in adolescents and young adults offers symptomatic and functional improvement in patients with ONFH. We found it to be safe with low perioperative complication rates even in patients undergoing active treatment for malignancy. Level of EvidenceLevel IV, case series study. See Instructions for authors for a complete description of levels of evidence.

Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture.

Traumatic hip dislocation can be isolated or associated with acetabular fracture. Both injuries require emergency reduction of the dislocated hip. Avascular necrosis of the femoral head (AVN) is a potential complication that accompanies these severe injuries. Our objective is to identify the risk factors that cause AVN. We retrospectively analyzed 44 patients with traumatic hip dislocations (Group A) and patients with posterior fracture-dislocation of the acetabulum (Group B). The average follow-up was 5.38years in Group A, 5.59years in Group B. We used the Thompson-Epstein classification for hip dislocation and the Harris Hip Score (HHS) for evaluating final outcomes. In Group A, we analyzed 21 patients with isolated posterior hip dislocation. We had one (4.76%) case of AVN. In Group B, we analyzed 23 patients with posterior acetabular fracture-dislocation. We had eight (34.78%) patients with AVN (p = 0.016, p < 0.05). With hip reduced 6-12h after injury, we had AVN in one (4.34%) patient, with reduction 12-24h, AVN was present in two (8.69%), while in hip reduction done after 24h of injury, AVN was present in five (21.73%) patients (p = 0.030, p < 0.05). An essential prerequisite for the prevention of AVN of the femoral head after hip dislocation is emergency hip reduction. In acetabular fracture-dislocation, emergency hip reduction, anatomical reduction of the acetabular fracture and early stable osteosynthesis are also important. Main factor affecting the development of AVN is late reduction of the hip.

Dislocation rate and its risk factors in total hip arthroplasty with concurrent extensive spinal corrective fusion with pelvic fixation for adult spinal deformity.

Though there are several reports on the high dislocation rates following total hip arthroplasty (THA) before or after spinal surgery, the literature specific to extensive spinal corrective fusion with pelvic fixation for adult spinal deformity is limited. This study determined the rate and risk of hip dislocation after THA and extensive spinal corrective fusion. We retrospectively analyzed the data of 23 adults (27 hips) who underwent both extensive spinal corrective fusion with pelvic fixation and THA between 2010 and 2018. Surgery-related characteristics were investigated from medical records, while standing anteroposterior pelvic radiographs and lateral spinal radiographs were used to measure spinal alignment parameters and THA acetabular orientation. Patients were grouped based on the occurrence of dislocation, and the rate and risk of dislocation were compared. The rate of THA dislocations was extremely high-22% (6 of 27 hips) of patients. All dislocations occurred posteriorly in patients with prior THAs that were performed using the posterior approach. The pelvic tilt was significantly greater in patients with THA dislocations (p = 0.02) than in those without. Cup radiographic anteversion in the supine (p = 0.02) and standing (p = 0.05) positions was significantly smaller in patients with dislocations than in those without. Total hip arthroplasty concurrent with extensive spinal corrective fusion with pelvic fixation for adult spinal deformity has an extremely high rate of posterior hip dislocation. The posterior surgical approach and prior THA were high risk factors for dislocation. Hip and spine surgeons need focused pre-surgical planning to account for this risk.

Neglected posterior hip dislocation: management of an 18 years old female

Neglected posterior hip dislocation: management of an 18 years old female

Neglected Posterior Dislocation of Hip in Children -A Case Report

Neglected Posterior Dislocation of Hip in Children -A Case Report

Results of surgical hip dislocation in the management of irreducible hip fracture-dislocation with femoral head fracture: a case series

Background: Posterior hip dislocation with femoral head fracture is among the complicated injuries. The purpose of the study was to define the common pathology of the hips with irreducible posterior dislocation combined with femoral head fracture and the outcome of surgical treatment using surgical hip dislocation technique. Methods: All the cases of irreducible posterior hip dislocation with femoral head fracture which underwent surgical hip dislocation were included in the study. Patients evaluated by Merle daubing & Postel and Thompson & Epstein scores clinical and radiographically. Results: seven men with the mean age of 31±7 years included. The delay between injury and attempted surgery was 22 ± 14 hours. After 67 ± 10 months of follow up five patients have excellent, one has good and one fair results. Fair result was in a patient who underwent surgery with 36 hours delay from injury complicated with Femoral head osteonecrosis. Conclusion: Hip dislocation as an effective technique in managing irreducible hip fracture-dislocations.

A PROSPECTIVE STUDY OF COMPLICATIONS IN BIPOLAR HEMIARTHROPLASTY USING MODIFIED HARDINGE APPROACH IN THE MANAGEMENT OF FEMORAL NECK FRACTURES

Introduction: Fracture of femoral neck is on the rise in the recent years owing to the increase in the geriatric population, severe osteoporosis and increased brittleness of the bone with advancing age. Total hip replacement was mostly used in the initial days but owing to higher chances of dislocations, it is less preferred. Bipolar hemiarthroplasty has become one of the main methods of treatment. A variety of surgical approaches have been used. Posterior approach is the most preferred approach currently, followed by Hardinge approach. Complications like dislocation, infection and abductor lurch are still common with current approaches. This study was undertaken to show the functional outcomes of a Modified Hardinge approach which seems to have optimal results out of all the approaches.&#x0D; Aim: To evaluate the functional outcomes and complications of modified hardinge approach.&#x0D; Materials and Methods: A total of 20 patients with fracture neck of femur were taken into the study and treated with Bipolar Hemiarthroplasty using modified Hardinge approach between June 2018 and October 2019. Each patient was put through the same preoperative and postoperative protocols. They was screened for comorbidities and were taken up for surgery. Complications after this approach were evaluated post operatively for a period of 6 months.&#x0D; Results: The mean hip score was 80. Complications like posterior hip dislocation and infection were nil. Abductor lurch was not noted in any of the patients. One patient had infection out of 20 which was managed accordingly.&#x0D; Conclusion: Bipolar hemiarthroplasty through modified Hardinge approach can be used in the management of femoral neck fractures with lowest complication rate. Complications like posterior dislocation and abductor lurch were nil in the study. The only downside of the procedure being a longer learning curve makes it a less used approach compared to others.&#x0D; Keywords: Hemiarthroplasty, modified Hardinge approach, femoral neck fracture

Floating hip: A unique pattern of injury

Floating hip is a rare injury, usually involved in high energy trauma. The classification and the guidelines for management of such rare injury is debatable in the literatures. I’m reporting a case of a 37-year-old male presented to my hospital with a transverse and posterior wall fracture of the right acetabular, ipsilateral proximal femoral shaft fracture and posterior hip dislocation. To my knowledge, this case is unique in presentation. Closed reduction failed, hence an open reduction internal fixation of his hip fracture-dislocation and acetabular fracture by plate and screws were done.

Recurrent traumatic posterior dislocation of hip in a 5-year-old boy

Recurrent traumatic posterior dislocation of the hip is a rare entity in the paediatric age group. We report an exceptional case of a 5-year old boy who sustained a posterior dislocation of the right hip joint following recurrent trivial trauma while playing, three times in the past one and half year. On literature review, we found that only a few cases have been reported and the management options still remain controversial.

Effectiveness of proximal femur reconstruction combined with total hip arthroplasty for Crowe type Ⅳ developmental dysplasia of hip

To investigate the early effectiveness of proximal femur reconstruction combined with total hip arthroplasty (THA) in the treatment of adult Crowe type Ⅳ developmental dysplasia of the hip (DDH). Between May 2015 and March 2018, 29 cases (33 hips) suffering from Crowe type Ⅳ DDH were treated with proximal femur reconstruction combined with THA. Of the 29 cases, there were 6 males (7 hips) and 23 females (26 hips), aged from 24 to 74 years with an average age of 44.9 years. The preoperative Harris hip score was 44.0±12.0. Gait abnormalities were found in all of the 33 hips with positive Trendelenburg sign, and the lower limb discrepancy was (3.8±1.6) cm. Preoperative X-ray films and CT both indicated serious anatomical abnormalities, including complete dislocation of the affected hip with significant move-up of the greater trochanter, abnormal development of the femoral neck, abnormal anterversion angle and neck-shaft angle, dysplasia of proximal femur and dysplasia of medullary cavity. The operation time, intraoperative blood loss, transfusion rate, and complications were recorded. The Gruen and DeLee-Charnley zoning methods were used to evaluate the aseptic loosening of the prosthesis on X-ray films. The Harris score was used to evaluate hip function. The lower limb discrepancy was calculated and compared with the preoperative value. The operation time ranged from 80 to 240 minutes, with an average of 124.8 minutes. The intraoperative blood loss ranged from 165 to 1 300 mL, with an average of 568.4 mL. Seventeen patients (51.5%) received blood transfusion treatment. All the incisions healed by first intention without infection or deep vein thrombosis. All patients were followed up 19-53 months, with an average of 33 months. One patient had posterior hip dislocation because of falling from the bed at 4 weeks after operation, and was treated with manual reduction and fixation with abduction brace for 4 weeks, and no dislocation occurred during next 12-month follow-up. Two patients developed sciatic nerve palsy of the affected limbs after operation and were treated with mecobalamin, and recovered completely at 12 weeks later. Trendelenburg sign was positive in 3 patients and mild claudication occurred in 4 patients after operation. X-ray films showed that all the osteotomy sites healed at 3-6 months after operation, and no wire fracture was observed during the follow-up. The Harris score was 89.8±2.8 and lower limb discrepancy was (0.6±0.4) cm at last follow-up, both improved significantly ( t=-22.917, P=0.000; t=11.958, P=0.000). The prosthesis of femur and acetabulum showed no obvious loosening and displacement, and achieved good bone ingrowth except 2 patients who had local osteolysis in the area of Gruen 1 and 7 around the femoral prosthesis, but no sign of loosening and sinking was observed. The treatment of Crowe Ⅳ DDH with proximal femur reconstruction and THA was satisfactory in the early postoperative period. The reconstruction technique of proximal femur can effectively restore the anatomical structure of proximal femur, which is one of the effective methods to deal with the deformity of proximal femur.

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.

Management of Recurrent Posterior Hip Dislocation in a Down Syndrome Patient with Dysplastic Hip Using Ganz Periacetabular Osteotomy: Follow Up After 4 Years

Recurrent hip dislocation in a Down Syndrome patient with dysplastic hip is a very challenging case to treat even for an expert orthopaedic hip surgeon. Least compliant patient and family, lowly educated with low socioeconomic status and the dysplastic hip forces limited option as a treatment. This is the first case world wide reporting 4 year follow up of dysplastic hip with Down Syndrome treated successfully with PAO technique.Methods:An eighteen years old female with history of Down Syndrome had multiple posterior hip dislocation episodes since 3 years prior. Several attempts of close reduction and hip spica applications were performed upon dislocation despite no successful retaining of reduction. Acetabular index of right hip were 550 and epiphyseal plate hasclosed. PatientwasperformedopenreductionusingSouthern-Mooreposteriorapproachand osteotomy of ischium, continued with capsulorrhaphy followed with Smith-Peterson anterior approach and osteotomy of superior ramus pubis and iliac bone. Then, derotation maneuver was performed under image intensifier to obtain adequate coveragefollowedwithbonegraftandfixationusing2cannulatedscrewandhipspica castapplication.Results:Within four years after surgery, the hip has never been dislocated again, patient could sit without pain and walk with full weight bearing although Harris Hip Score could not be performed due to Down Syndrome. Leg length discrepancy was negligible,fracture has fully united and acetabularin dex was300.Conclusions:Ganz periacetabular osteotomy, although a technically demanding surgery, is a preferable treatment in recurrent hip dislocation for Down Syndrome patient with good to excellent clinical and radiological ou tcome

Neglected Traumatic Posterior Dislocation of Hip in Children: Report on 2 cases

Neglected traumatic dislocation of the hip is extremely rare in children and the preferred treatment may still be debatable. In literature definition of old or late dislocation is not clear. According to Garrett et al (1979) that patients who were not treated within 72 hours after injury were called as old unreduced dislocation of hip (1). The option of management of hip dislocation in children are closed and open reduction, subtrochanter osteotomy, arthrodesis, or leave as such and wait for adulthood for total hip replacement (2). Here we present 2 cases of neglected traumatic posterior dislocation management and their outcomes. First came to hospital 10 weeks after trauma, second case came 32 weeks after. First case was treated by closed reduction and percutaneous K-wiring while second was performed adductor tenotomy before open reduction and internal fixation by K wire through the femoral head into acetabulum. Hip spica was applied post operatively. The K wire was removed at 6 weeks. Patients were allowed to bear weight from gradual to full weight bearing after 6 weeks.Discussion:Traumatic hip dislocations are rare in children accounting for less than 5% of all pediatric dislocation (4). Large series has shown this injury 25 times, less common in children than adults (5). It is further rare to see neglected dislocation in pediatric age group. Various studies reported difference methods for management. The options are close and open reduction, sub trochantric osteotomy, arthrodesis, pelvis osteotomy or leave and wait for adulthood (2). According to some studies, close reduction is possible if dislocation is of a relatively short duration (2-4 weeks) (5). Closed reduction and skeletal traction with the limb in abduction has some good results in selected cases (6). Gupta and Shrevet reported good results with the use of heavy traction and sedation (7). Pai and Kumar in their study of eight patients with neglected posterior dislocation concluded that 66% of the patients with dislocation less than 1 year old can be reduced by traction and abduction (3). In our cases, pre-reduction traction had been used temporary with the believe that the traction would stretch the soft tissue that create excessive pressure on the femoral head, making operative intervention easier. Kumar and Jain (8, 9) in their study of 18 patients treated by open reduction after skeletal traction was unsuccessful. Despite varying degree of avascular necrosis, the reported excellent results in 17 patients. In children, traumatic hip dislocation may lead complication such as recurrent dislocation, sciatic nerve palsy, post traumatic degeneration arthritis, coxa magna and avascular necrosis (10, 11). Somehow among all complication, AVN has the worst prognosis (10, 11, 12). AVN usually develops in the first three years (10,11). AVN reaches up to 100% in neglected traumatic hip dislocation patient (13). Growth disturbances develops due to proximal physical damage and effects especially children under the age of 12 and it may lead to leg length discrepancy and angular deformity in femoral neck (14). Growth disturbance usually emerges as coxa magna in children older than 12 years. Coxa magna was also encountered in our case. The resultant coxa magna seen on radiographs here not caused hip symptom years after but predispose hip to secondary osteoarthritis.Conclusion:Intra-articular normal saline (IA-NS) injections have been utilized as a placebo in a number of researches pertaining to the management of joints problem such as knee osteoarthritis (OA). It is believed that these IA-NS injections may have a therapeutic effect that has not been quantified in the literature. Lidocaine have some mild anti-inflammatory effect during its relatively short halflife of 1.5 hours. The prompt effect of the local anesthetic providing temporary relief of symptoms can help confirm proper placement of the injection and support that the site injected was the source of the pain.Conclusion:Neglected traumatic posterior dislocation of the hip can be treated with closed reduction or open reduction. Repetitive closed reduction trial should be avoided. It should be kept in mind that the rate of avascular necrosis may reach up to 100%.

Traumatic dislocations of the hip in children About 11 cases and literature review

Traumatic dislocation of the hip in childhood is rare. Several small series of this condition have been published. The objective of this study was to evaluate the outcome of treatment of traumatic posterior hip dislocation in children. Data from 11 children (11 hips) with traumatic hip dislocation, collected in 2 centres (2 countries), from January 2010 to January 2019 were analysed. The clinical assessment focused on symptoms and physical findings. X-rays identified the type of hip dislocation. Hip dislocations were classified according to Thompson and Epstein. Reduction was performed using three techniques: technique 1, closed reduction. Technique 2, release of the long adductor muscle, lengthening of the psoas tendon, and placement of a Kirschner wire through the femoral head into the acetabulum. Technique 3, open reduction after hip arthrolysis. X-rays were then used to determine whether the hip is concentric and to check for any other injuries that may have occurred after manipulation. There were 3 girls (27.3%) and 8 boys (72.7%) in this study.

Transfer of osteochondral shell autografts to salvage femoral head impaction injuries in hip trauma patients

IntroductionFemoral head impaction defects are observed with variable severity, as a result of traumatic hip dislocations which can be caused by traffic accidents or seen in professional athletes amongst other mechanisms. Compression of the articular cartilage and the subchondral bone into the femoral head results in irregular articular surfaces influencing the outcome with predisposition to osteoarthritis, and being predictive for the need for delayed total hip replacement. This study reports the outcome after a minimum follow-up (FU) of five years in a consecutive series treated with transfer of osteochondral shell autografts in hips (TOSAH) from the head-neck junction into the defect using surgical hip dislocation. Patients and methodsBetween 06/2007 and 03/2014 a series of twelve consecutive patients (mean age: 35yrs, range 18–53; median Injury Severity Score: 12, range 9–27) sustained a traumatic posterior hip dislocation in combination with acetabular and/or Pipkin fractures and were inter alia treated using TOSAH using surgical hip dislocation. Conversion to total hip replacement (THR) during FU was noted as failure. Patients were clinically (Merle d'Aubigné score) and radiographically assessed for occurrence of osteoarthritis (OA), avascular necrosis (AVN) and/or heterotopic ossification (HO) at a minimal follow-up of five years. ResultsMean follow-up was 6.9 years (5.0–11.6). At five-year follow-up, we found a survivorship of 57.1% (95% Confidence interval {CI}, 46.7–100%). Four patients required conversion to a total hip replacement at 11, 16, 28 and 44 months respectively after the TOSAH procedure due to osteoarthritis progression. One patient required conversion to a total hip replacement 12 months after TOSAH procedure due to AVN. One patient was lost to follow-up after 2.7 years. The remaining six patients with preserved hips presented with a median Merle-d'Aubigné score of 16 points (range: 14–18) and no AVN. Two patients showed asymptomatic grade I osteoarthritis according to Tönnis at latest follow-up and three patients showed mild asymptomatic HO according to Brooker (Grade I-II). ConclusionThe presented technique can be used as a salvage procedure for severely injured hip joints and to preserve the hip joint at midterm with satisfying clinical and radiological outcomes.

Application of self-made spring plate for treatment of acetabular posterior wall fractures

To investigate the application and effectiveness of self-made spring plate in surgical treatment of acetabular posterior wall fracturejavascript:void(0)s. Between June 2013 and June 2017, 38 patients with acetabular posterior wall fractures were treated. There were 27 males and 11 females with an average age of 53 years (range, 28-68 years). The injury caused by traffic accident in 18 cases, falling from height in 15 cases, and tumble in 5 cases. There were 4 cases of simple posterior wall fracture, 18 cases of posterior wall fracture with posterior dislocation of hip joint, 10 cases of posterior wall fracture with posterior column fracture, and 6 cases of posterior wall fracture with transverse fracture. The time from injury to admission was 1-4 days (mean, 2.5 days). The time from injury to operation was 4-8 days (mean, 5 days). After fracture reduction via the Kocher-Langenbeck approach (35 cases) or the combined ilioinguinal approach (3 cases), the spring plate was used to press the posterior wall fracture, and then the reconstruction plate was pressed against the spring plate and fixed to the posterior column. All the incisions healed by first intention. All patients were followed up 12-36 months (mean, 28 months). Five cases of post-traumatic sciatic nerve injury and 2 cases of sciatic nerve injury caused by traction during operation were fully recovered at 3 months after operation. The imaging examination showed that all the fractures healed. The fracture healing time was 10-16 weeks (mean, 12 weeks). There was no ruptures or failures of internal fixation during the follow-up period. There were 2 cases of femoral head necrosis, 1 case of traumatic arthritis, and 1 case of osteomyositis at last follow-up. The hip joint function was rated as excellent in 27 cases, good in 5 cases, fair in 2 cases, and poor in 4 cases according to the Harris scores at 12 months after operation. For the acetabular posterior wall fracture, it has the advantages of easy to use and reliable fixation that the posterior wall fracture is fixed with spring plate firstly, and the spring plate is pressed to fix the posterior column with the reconstruction plate finally.

Schatzker Type VI Injury with Missed Posterior Dislocation of the Hip

ABSTRACT Introduction Posterior dislocation of the hip can be an associated injury with fracture neck and shaft of the femur fractures. Case description A 33-year-old male came to us with above knee slab of the left leg. He had a fall from the bike and took initial treatment elsewhere. The X-ray and diagnosis of Schatzker type VI injury of the left knee were already done in the previous hospital. The upper tibia fixed with L-plate with screws. When the patient started walking in parallel bar, he felt twisting strain on the left hip and complained of pain in the left hip region. Now, the patient had shortening and internal rotation of the left lower limb. Clinically diagnosed posterior dislocation of the left hip was confirmed with X-ray. Reduction of dislocation was done. Conclusion X-rays of proximal and distal joints are mandatory. The statement stands testimony every time. How to cite this article Mothilal M, Khader FA, Rajan TS, et al. Schatzker Type VI Injury with Missed Posterior Dislocation of the Hip. J Orth Joint Surg 2020;2(1):43–45.

Neglected Hip Dislocation with Posterior Wall Acetabulum Fracture for 4 years : an unusual presentation: management : A Case Report.

Neglected traumatic hip dislocation is not an uncommon condition seen in developing countries. In our case 26 years old male with neglected right posterior superior hip dislocation with deficit posterior acetabular wall (figure 1 and 2) with limb length discrepancy of 7cm, Harris hip score 46,presented to our hospital after 4 years of accident. He had gone multiple treatments for his right dislocated hip but was unsuccessful. In our hospital patient was patient was managed with un-cemented total hip arthroplasty with posterior acetabular wall reconstruction. On follow up hip joint shows good range of movements with no pain and limb length discrepancy of about 1 cm and Harris hip score 82. So THR provides good results in neglected hip dislocation with acetabular fractures. Keywords: Dislocation. Fracture. Total hip arthroplasty