Traumatic Hip Dislocation Research Articles

Incidence of canine hip dysplasia - a prospective study of one year

A study was conducted to assess the prevalence of canine hip dysplasia (CHD) among dog population during a period of one year from January 2021 to December 2021. Canine hip dysplasia was confirmed by clinical orthopedic and radiographic examinations. Of the 231 dogs presented with lameness suspected to be originating from hip joint, 140 animals had dysplastic hips. The incidence was more in large breeds of dogs in an age group of 6 months to 12 months. Thirty five percent of the animals showed unilateral affection while in the remaining 65 percent it was bilateral. Females were more affected with this condition as per the findings of this study. Other than hip dysplasia, traumatic hip dislocation and osteoarthritis contributed to lameness originating from hip joints.

Comparing Propofol With Fentanyl and Midazolam for Sedation in Closed Reductions of Traumatic Hip Dislocations.

Traumatic native hip dislocations require prompt reduction of the dislocation to limit the risk of avascular necrosis and resultant hip arthrosis. Although closed reduction under sedation is frequently attempted, there is minimal evidence about which sedative agent is most safe and effective. The goal of this study was to compare the efficacy of propofol vs combination fentanyl/midazolam for closed reduction under sedation of traumatic native hip dislocations. This was a single-center retrospective review. The main outcome measures were the rate of successful closed reduction with propofol vs combination fentanyl/midazolam and time from the start of sedation to radiographic evidence of reduction. Fifty-four patients with traumatic native hip dislocations were identified. Closed reduction under sedation with propofol was successful in 11 of 14 attempts compared with 4 of 11 attempts with combination fentanyl/midazolam (P=.04). The fentanyl/midazolam group had 6.4 times the odds (95% CI, 1.1-37.7) of failed closed reduction compared with the propofol group. The median time to reduction in the propofol group was 14 minutes vs 45 minutes for the fentanyl/midazolam group (P=.18). Patients who had failed closed reduction with fentanyl/midazolam had a median time to reduction of 100 minutes. There was no difference in sedation-related complications between the 2 groups. We therefore conclude that sedation with propofol is significantly more effective than combination fentanyl/midazolam for closed reduction of native hip dislocations. To minimize unsuccessful reduction attempts and shorten total time to reduction, we recommend against the use of combination fentanyl/midazolam because of the high risk of failure. [Orthopedics. 2023;46(2):86-92.].

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

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

Posterior acetabular wall morphology is an independent risk factor that affects the occurrence of acetabular wall fracture in patients with traumatic, posterior hip dislocation

PurposeSmaller posterior acetabular walls have been shown to independently influence the risk for bipolar hip dislocation. We asked whether differences would also be observed in patients with traumatic posterior hip dislocation with and without posterior wall fractures.MethodsBetween 2012 and 2020 we observed 67 traumatic posterior hip dislocations. Of these, 43 traumatic posterior hip dislocations in 41 patients met the inclusion criteria. Eighteen dislocations were excluded with an acetabular fracture other than posterior wall fracture and six dislocations had insufficient computed tomography (CT) data. The mean age was 41 ± 11 years, 32 males and nine females. We observed 26 traumatic hip dislocations with posterior wall fractures and 17 without. All patients underwent polytrauma CT scans and postoperative/postinterventional pelvic CT scans. On axial CT-scans, posterior wall determining angles were measured.ResultsPatients with posterior wall fractures were not significantly older than patients without posterior wall fractures (42 ± 12 vs. 38 ± 10 years; p = 0.17). Patients without posterior wall fractures had significantly smaller posterior acetabular sector angles (84° ± 10°) than did patients with posterior wall fractures (105° ± 12°) (p < 0.01; OR 1.178). Likewise, the posterior wall angle was significantly smaller in patients without posterior wall fracture (62° ± 9°) than in those with posterior wall fractures (71° ± 8°) (p < 0.01; OR 1.141).ConclusionBoth posterior acetabular sector angle and posterior wall angle are independent factors determining the posterior wall fracture morphology in patients with traumatic posterior hip dislocation. Age and the observed trauma mechanism did not differentiate between traumatic posterior hip dislocations with and without posterior wall fractures.

A Rare Case : Traumatic Posterior Hip Dislocation Associated with Anterior Column and Incomplete Posterior Column Acetabular Fracture

Introduction: The hip is among the most solid joints within the human body that took a lot of force to dislocate it. Hip dislocation is frequently associated with acetabulum fracture. Although traumatic posterior hip dislocation is rarely involved anterior column fracture. Case Presentation: We describe a rare case of traumatic posterior dislocation of hip associated with anterior column and incomplete posterior column acetabular fracture in a young female following road traffic accident. The patient hip dislocation was reduced with closed reduction and perfomed open reduction and fixation under C-Arm for acetabular fracture management. Assessment of anterior and posterior acetabular column was revealed stable after fixation. The goals are to maximize the patient's ability to function, enable early recovery to function. The patient was able to flex her left hip at 6 weeks after the surgery. Conclusion: This case highlights a rare case of the traumatic posterior hip dislocation associated with anterior column and incomplete posterior column acetabular fracture, attempts to elucidate the mechanism of injury and perform prompt reduction to achieve a better patient outcome.

A Rare Case : Traumatic Posterior Hip Dislocation Associated with Anterior Column and Incomplete Posterior Column Acetabular Fracture

A Rare Case : Traumatic Posterior Hip Dislocation Associated with Anterior Column and Incomplete Posterior Column Acetabular Fracture

Traumatic posterior dislocation of hip with ipsilateral fracture of shaft of the femur: external maneuvers reduction and osteosynthesis by screw plate about a case and review of literature at Tambacounda regional hospital in Senegal

&lt;p&gt;Traumatic hip dislocation associated with an ipsilateral femoral fracture is a rare injury. It occurs in a high-energy traumatic context. The classic mechanism consists of a fall with landing on the hip, which initially dislocates and the femur fracture occurs secondarily by adduction of the proximal fragment. The diagnosis is difficult in front of the fracture whose signs mask the vicious attitude of the dislocation. We reported the case of a passenger of a motorcycle who collided with a parked car. He was ejected from the motorcycle and landed on his right hip. We performed X-rays of hip and lower limb at his admission which revealed a dislocation of hip in its high posterior variety and a medio-diaphyseal fracture of femur on same side. Reduction of dislocation by external maneuvers was made and osteosynthesis of femur with screwed plate performed 48 h later. After 16 months of care, functional and radiological results sufficient.&lt;/p&gt;

948 Traumatic Native Hip Dislocation Without Associated Fracture: A Case Series of 13 Patients Over 9 Years

Abstract Aim Traumatic native hip dislocation (NHD) is rarely without an associated fracture or due to low energy trauma. Posterior dislocation is the most common pattern of hip dislocation. In most cases, closed reduction is successful, but occasionally open reduction is required to achieve appropriate reduction. The aim of our study was to present the 9-year experience from our institution of this rare injury pattern and to comment on how our experience correlates with the current literature. Method This is a retrospective case series of all adult patients (&amp;gt; 16 years old) with a traumatic NHD without fracture presented and/or treated at our institution, between the 1st of January 2012 and 22nd June 2021. Results Thirteen cases of traumatic NHD were identified (38.4% female). The mean age was 26.5 years. Typically, younger patients were involved in lower energy injuries. The direction of hip dislocation was posterior in 10 cases. Associated injuries were seen in 3 patients. 12 cases underwent successful closed reduction, and 1 case was operatively managed. 3 cases had a previous hip pathology including femoroacetabular impingement, cam lesion and childhood slipped upper femoral epiphysis. Conclusions Traumatic NHD without associated fracture is a rare injury pattern, most commonly occurring in patients under the age of thirty. A target of 6 hours for reduction should be employed as this will reduce the risk of AVN in those who have not permanently damaged the vessels at the time of injury.

Pulmonary embolism following reduction of traumatic anterior hip dislocation- A case report and review of literature

Anterior hip dislocations are uncommon, but are associated with the risk of occlusion of major vessels of the limb. We report a case of traumatic anterior hip dislocation who had an on-table cardiac arrest following reduction of hip. It was due to pulmonary embolism, and delayed presentation increased the risk for the same. It was an unanticipated event for us and we wish for all the providers to be aware of this occurrence.

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.

Reconstruction of Tumor-Induced Pelvic Defects With Customized, Three-Dimensional Printed Prostheses.

BackgroundReconstruction of pelvis girdle stability after tumor-induced hemipelvectomy remains challenging. We surgically treated 13 patients with custom-made, three-dimensional printed hemipelvic prostheses. We aim to identify the preliminary outcomes for patients who have been managed with more mixed regions of prosthetic pelvic reconstruction and the feasibility of two reconstructive systems.MethodsSeven male patients and 6 female patients treated at our center between January 2019 and May 2021 were included. There were 11 primary sarcomas and 2 solitary bone metastases. After en bloc tumor resection, two types of personalized, three-dimensional printed prostheses were fixed to restore the stability and rebuild the load transfer. The position of the reconstructed hemipelvis was evaluated on an anteroposterior plain radiograph. The complications and outcomes were traced. One amputation specimen was discovered through histological analysis of the porous structure.ResultsThe operative duration was 467 ± 144 min, and the blood loss was 3,119 ± 662 ml. During a follow-up of 22.4 ± 8.5 months, two patients had delayed wound healing and one had a second-stage flap transfer. One patient with osteosarcoma died of pulmonary metastasis 27 months after surgery. Two patients with marginal resection suffered from local recurrence and had extra surgeries. One patient had traumatic hip dislocation 2 months after surgery and manipulative reduction was performed. The acetabular inclination of the affected side was 42.2 ± 4.3°, compared with 42.1 ± 3.9° on the contralateral side. The horizontal distance between the center of the femoral head and the middle vertical line was 10.4 ± 0.6 cm, while the reconstructed side was 9.8 ± 0.8 cm. No significant difference in acetabular position after surgery was found (p > 0.05). The amputation specimen harvested from one patient with local recurrence demonstrated bone and soft tissue ingrowth within the three-dimensional printed trabecular structure. Walking ability was preserved in all patients who are still alive and no prosthesis-related complications occurred. The MSTS score was 22.0 ± 3.7.ConclusionsBoth types of custom-made, three-dimensional printed prostheses manifested excellent precision, mechanical stability, and promising functional rehabilitation. The porous structure exhibited favorable histocompatibility to facilitate the ingrowth of bone and soft tissue.

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.

Posterior Dislocation Of The Hip Joint Due To Trauma In Children: A Three-Case Series

Aim: To appraise cases that presented with posterior dislocation of the hip secondary to trauma in paediatric age group and to analyse difficulties along with challenges that arise in the diagnosis (both radiological and clinical), treatment plan, complications and the outcome of such injury in children. Methods: Three children with traumatic posterior hip dislocation and a mean age of 3.3±0.47 years who were followed-up at 6 months were assessed. Results: The primary early treatment was closed reduction, executed within six hours of injury. The three subjects were treated with reduction under anaesthesia. The adjuvant treatment was immobilization via hip spica. Follow up was uneventful. Conclusion: Dislocation of the hip joint due to trauma should be attended to as early as possible with emphasis on achieving anatomical reduction preferably via reduction and close follow up. Keywords: Hip joint, posterior dislocation, trauma

Avascular Necrosis of the Femoral Head After Recurrent Traumatic Posterior Hip Dislocation in a 10-Year-Old Girl: A Case Report

Background: Traumatic hip dislocation (THD) is a rare pathology in the pediatric population. The severity of the trauma, mismanagement, or late treatment of such pathology can lead to complications, including avascular necrosis (AVN) of the femoral head. We hereby report a case of recurrent traumatic posterior hip dislocation that eventually lead to AVN of the femoral head in a 10-year-old girl. Case presentation: A 10-year-old girl presented to the Emergency Department complaining of left hip pain one day following a fall from a standing position. On physical examination, the left hip was held in the position of flexion, adduction, and internal rotation, with complete loss of range of motion of the left hip joint. Radiographic imaging was done and showed: a posterior dislocation of the left hip, enlargement of the growth cartilage of the left femoral epiphysis, and hypertransparency of the anterosuperior corner of the left femoral neck, and increased bone density of the upper left femoral epiphysis, suggesting previous hip dislocations. Open reduction with arthrotomy and posterior capsulorrhaphy was performed 36 hours post-injury, followed by hip immobilization by a spica cast. Two months after surgery, the cast was removed. On examination, the left hip was stable with good mobility, and weight-bearing was authorized. Follow-up was done three months post-injury. The patient had no complaints, but radiographic images showed signs of avascular necrosis (AVN) on the left femoral head. Conclusion: Our case emphasizes the importance of early diagnosis and management of a THD in pediatrics, to prevent serious complications such as AVN.

Traumatic Hip Dislocations in the Pediatric Patient: Injury Patterns, Need for Axial Imaging, Outcomes, and Selective Hip Arthroscopy

Background: Traumatic hip dislocations are uncommon injuries in the pediatric population. Injury recognition and prompt closed reduction is standard of care. The purpose of this study is to describe injury patterns, treatment (including hip arthroscopy), and patient reported outcomes of traumatic hip dislocation in pediatric patients. Methods: A retrospective review was performed of all patients less than 18 years of age treated for a traumatic hip dislocation between 2011 – 2017 at a single center. Chart and radiographic review were performed, and patients were contacted to obtain outcome scores, including the Harris hip score (HHS) and hip outcome score (HOS). Results: 23 patients, 18 males and 5 females, with a mean age of 11.3 years (range 4 – 16) were included. The most common mechanisms of injury were motor vehicle crashes (8), football (7), and falls (3). The direction of hip dislocation was posterior (21) and obturator (2). Twenty patients had a CT to assess the hip reduction and associated injuries and 15 (75%) had a posterior wall acetabular fracture and 6 (30%) had an incarcerated fragment within the joint. 5 patients had an MRI and all had an associated posterior wall fracture and posterior labral tear. Fourteen patients were treated non-operatively. Patient-reported outcome scores were obtained in 10 patients (71%). Mean HOS-ADL, HOS-Sport, and mHHS were 75 (69 – 76), 32 (18 – 36), and 97 (85 – 100) respectively at a mean of 40 months after injury. Nine patients were treated operatively, including 5 patients with hip arthroscopy. Patient-reported outcome scores were obtained in 7 patients (78%). Mean HOS-ADL, HOS-Sport, and mHHS were 69 (50 – 76), 30 (14 – 36), and 86 (59 – 100) respectively at a mean of 34 months after surgery. Conclusion: Traumatic hip dislocations in the pediatric population occur most frequently as isolated orthopaedic injuries in association with posterior wall acetabular fractures. Incarcerated fragments occurred in 30% of the patients, yet were commonly not recognized on plain radiographs alone. Axial imaging should be routinely obtained following reduction. Selective hip arthroscopy after traumatic hip dislocations is a viable less invasive method for treatment of incarcerated fragments and labral injury.

Epidemiology of Sports-Related Traumatic Hip Dislocations Reported in United States Emergency Departments, 2010-2019.

Background:Traumatic hip dislocations are rare injuries that most commonly occur in motor vehicle accidents. There is a paucity of literature that describes sports-related hip dislocations.Purpose:To estimate the incidence of sports-related hip dislocations and determine any sport- or sex-related epidemiological trends using the National Electronic Injury Surveillance System (NEISS) database.Study Design:Descriptive epidemiology study.Methods:Data regarding sports-related hip dislocations from 2010 to 2019 were retrieved from the NEISS, a database that catalogs injury information during emergency department visits from 100 hospitals across the United States to produce nationwide estimates of the injury burden. The estimated number of injuries was calculated using weights assigned by the NEISS database. The injuries were then stratified by sport and sex to determine any epidemiological patterns.Results:A total of 102 hip dislocation injuries were identified over the surveyed 10 years, indicating 2941 estimated injuries nationwide. Overall, 10 (9.8%) of 102 sports-related hip dislocations presented with concomitant acetabular fractures, representing an estimated 288 injuries nationally over 10 years. Male athletes sustained more sports-related hip dislocations than female athletes, with a relative incidence of 12.51 (P < .001). Adolescents aged 15 to 19 years recorded the highest number of hip dislocations. There were 17 sports identified as having caused at least 1 hip dislocation over the 10-year period. More hip dislocation injuries were sustained from contact sports (91.2%) than noncontact sports (8.8%) (P < .001). Football (estimated 164 injuries per year; 55.6%), snowboarding (28 per year; 9.5%), skiing (26 per year; 8.8%), and basketball (21 per year; 7.1%) had the highest rates of hip dislocation. Additionally, 43 (82.7%) football-related injuries were caused by tackling mechanisms, and 9 (17.3%) were caused by nontackling mechanisms (P < .001).Conclusion:The incidence of traumatic sports-related hip dislocations was extremely low in the United States during the study period. Male adolescents, aged 15 to 19 years, sustained the greatest number of injuries during football. Significantly more hip dislocations occurred in contact sports, most commonly football, snowboarding, skiing, and basketball, compared with noncontact sports. As adolescent athletes may have limited treatment options if osteonecrosis occurs, these data serve to increase the clinical awareness of these injuries.

Traumatic Hip Dislocation Associated with Proximal Femoral Physeal Fractures in Children: A Systematic Review.

Traumatic hip dislocation might lead to serious complications and a poor outcome. Fortunately, it is a rare condition in pediatric patients. The purpose of this study is to establish and describe the complications caused by hip dislocations associated with transphyseal femoral neck fractures. Therefore, we conducted a literature review that resulted in 11 articles, including 32 patients, older than 10 years of age, suffering from traumatic hip dislocation associated with a transphyseal femoral neck fracture. We presented a case series of three patients with hip fracture-dislocation treated in our clinic that were also evaluated and included in the study. For the 35 patients included in the study group, the percentage of avascular osteonecrosis after hip fracture-dislocation was 88.57%. Traumatic hip dislocation associated with transphyseal femoral neck fracture is a rare condition and has a poor prognosis because of the high incidence of femoral head avascular necrosis (AVN). Reduction should be attempted within six hours the from injury, but this may not minimize the risk of AVN if transphyseal separation occurs. The approach may influence the development of AVN; lateral approach of the hip with great trochanter osteotomy seems to have the lowest number of cases of AVN.

Aseptic necrosis of the femoral head as a complication of its traumatic dislocation

The work is based on the analysis of examination and treatment results in traumatic hip dislocation (52 patients). The development of aseptic femoral head necrosis was detected in 11 patients at follow-up from 2 to 5 years. Algorithm of complex examination and treatment in traumatic hip dislocation has been elaborated for early and long-term periods after trauma. The group of high risk for aseptic femoral head necrosis development includes the patients with concomitant trauma, with posterior, obturatory and central dislocation. Rehabilitation is requiered to all patients with traumatic hip dislocation in the period from 2 to 5 years taking into account the peculiarities of hip injury. If the signs of posttraumatic aseptic femoral head necrosis are detected at early stages, then conservative treatment is indicated. In advanced process the operative treatment is indicated. Localization of necrosis area within femoral head, necrosis extension and articular surface congruence are of importance for the choice of adequate operative treatment. Roentgenologic signs of irreversibility of articular tissues destruction are the indication for total hip replacement.

Traumatic Hip Dislocation: An Experience from a Public General Hospital of Brunei

Traumatic Hip Dislocation: An Experience from a Public General Hospital of Brunei

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.