Bilateral Asymmetric Hip Dislocation With Segmental Fracture Femur : An Unusual Case Report And Literature Review

摘要

Bilateral traumatic hip dislocation is rarely seen. A unique case is presented, consisting of bilateral asymmetric hip dislocation with associated segmental fracture femur, resulting from fall from train. This case represents an unusual, severe combination of injuries resulting from the fall from train under influence of alcohol. Traumatic hip dislocation represents a true orthopaedic emergency .Given the severity of associated complications, every effort should be made to ensure prompt diagnosis and immediate therapy. We report our experience in the management of this complex injury pattern and review the pertinent literature on this subject. Introduction Hip dislocation occur infrequently and almost always after traumatic injury . It accounts for 2 TO 5% of all dislocation (1,2). 85 to 90% are posterior dislocation (3) . Bilateral traumatic dislocation is a rare injury but 55 such cases have been reported in literature. Asymmetric bilateral hip dislocation is even rarer injury , with only 16 cases reported in English literature (2,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18). We report a unique case, simultaneous bilateral asymmetric dislocation with segmental fracture of femur caused by fall from train. Only two cases of bilateral asymmetric hip dislocation with associated femur fracture have been reported (8, 16), however there is no case of asymmetric bilateral hip dislocation associated with segmental fracture of femur in the English literature. Considering mode of trauma, no where among previous reports, fall from train as a cause of injury has been described. Case Report A 60 year old male who was weighing around 120kg was admitted to our centre after fall from train. He was standing next to door and fell down under influence of alcohol. Other than history of alcoholism, he had no history of past pelvic trauma, hip abnormality or ligamentous laxity. The patient arrived within 2 hours of injury and was slightly disoriented with smell of alcohol. There was no history suggestive of head injury. He was found to be hemodynamically stable with a Glasgow coma scale of 15 during initial evaluation . Chest, abdominal examination was normal and pelvis was found stable on compression. Multiple extremity abrasions were present and there were obvious deformities of both lower extremities and deformity of right thigh indicating femoral fracture. His left hip was abducted, flexed and externally rotated while his right hip was in flexion , adduction and internal rotation . There was gross swelling, tenderness of right thigh with crept, abnormal mobility at two sites; one at upper 3rd of thigh and another at lower 3rd of thigh . There was no distal neuro vascular deficit in either of lower limbs. (Figure-1)