Bilateral Asymmetric Hip Dislocations with Vascular Compromise: A Case Report
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CASE REPORT
Bilateral Asymmetric Hip Dislocations with Vascular Compromise: A Case Report Nitish Bansal1 · Parik Dev2 · Gitesh Singh1 · Ayush Jain1 · Akashdeep Singh1 Received: 7 August 2020 / Accepted: 3 September 2020 © Indian Orthopaedics Association 2020
Abstract Bilateral asymmetric hip dislocations are rare injuries and associated vascular compromise is even rarer. We report a unique case of bilateral asymmetric hip dislocations with vascular compromise, due to mechanical arterial compression by the anteriorly dislocated femoral head on one side. Prompt closed reduction re-established the blood flow. Operative intervention was done subsequently to remove intra-articular loose bodies in the hip on the same side. At 6-month follow-up, patient had good functional outcome and no radiographic evidence of complications. Keywords Bilateral asymmetric hip dislocations · Vascular compromise
Introduction Bilateral asymmetric hip dislocations are uncommon injuries constituting approximately 0.01–0.02% of all joint dislocations [1]. In this injury, one hip dislocates posteriorly, and the contralateral hip dislocates anteriorly. There have been multiple reports of this injury with discussions focusing on the mechanism of the injury, treatment, and outcomes. We report a unique case of bilateral asymmetric hip dislocations with vascular compromise on one side. This is only the second case with such a pattern of injury being reported in the literature.
Case Report A 20-year-old man, was an unrestrained front passenger in a motor vehicle traveling at high speeds and had a head-on collision with another vehicle. The patient was shifted to our hospital and after initial assessment and stabilisation, the patient was transferred to the orthopaedic department. The The study was performed at Department of Orthopaedics, GMC, Patiala, Punjab, India. * Nitish Bansal [email protected] 1
Department of Orthopaedics, GMC, Patiala, Punjab, India
Department of Orthopaedics, GSMCH, Patiala, Punjab, India
2
patient complained of pain in bilateral hips. His left lower limb was shortened, internally rotated and adducted with no distal neurovascular deficit. The right lower limb appeared slightly longer than the left, externally rotated and abducted, which was pale, cold to touch, with no pulses in the popliteal, dorsalis pedis and posterior tibial arteries and delayed capillary refill time with no distal neurological deficit. The deformity was akin to a windswept deformity of the lower limbs. An anterior–posterior radiograph of the pelvis with bilateral hips was taken and revealed bilateral asymmetric hip dislocations, with anterior dislocation of the right hip and posterior dislocation of the left hip (Fig. 1). The patient did not have any other associated injury apart from the bilateral hip dislocations. Under sedation, closed reduction of both hips was done. Upon reduction, the deformities in both the limbs were corrected with a return of palpable pulses in the popliteal, dorsalis pedis, and posterior tibial arteries
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