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| | | CASE REPORT | | | | | Year : 1991 | Volume : 37 | Issue : 2 | Page : 117-8,118A | Simultaneous anterior and posterior dislocation of hip (a case report).
Nadkarni JB
Department of Orthopaedics, L.T.M.M. College, Sion, Bombay, Maharashtra.
Correspondence Address:
Department of Orthopaedics, L.T.M.M. College, Sion, Bombay, Maharashtra.
A rare case of simultaneous anterior and posterior dislocation of hip joints is presented. The mode of injury and its management have been discussed.
How to cite this article:
Nadkarni J B. Simultaneous anterior and posterior dislocation of hip (a case report). J Postgrad Med 1991;37:117-8,118A |
Bilateral simultaneous dislocation of the hip joints is rare, and it accounts for 1 to 2% of all cases of hip dislocations[1]. Dislocations, with one hip dislocated anteriorly and the other posteriorly, are even more rare. Such an injury is usually associated with other major pelvic ring injuries or femoral fractures[1].
The present report describes a case of simultaneous anterior and posterior dislocation of the hip joints, without any major pelvic ring injuries. The mechanism of the injury, due to the position of the patient at the time of accident and the successful outcome following an early manipulative reduction and early active non weight bearing mobilisation is discussed.
A 22-year-old, tall (6'-3"), male driver of a mini car was admitted, following a road traffic accident, when his car skidded off the road and hit a tree head on. The patient had scat belt on, and was unable to move following the accident. He had to be dragged out of the car. Clinical examination on admission revealed a healthy inale, who was fully conscious and orientated. The vital signs were normal and examination of the head and neck, chest, abdomen and the spine was normal. The left hip was flexed, adducted and externally rotated, and the right hip was flexed adducted and internally rotated. Distal circulation and neurology in both lower limbs was normal. There were minor abrasions over the left knee. Radiographs of the pelvis (See [Figure - 1]), showed a posterior dislocation of the right hip and an obturator dislocation of the left hip. Tlere was an undisplaced incomplete fracture of the right ilium. Both the hips were successfully manipulated under general anaesthesia, within two hours of the injury. Both the hips were stable following reduction and the post-reduction radiographs showed the hips in antomical position.
Tle patient was kept, on bilateral skin traction and active hip exercises commenced at three weeks. The traction was maintained for six weeks, and gradual weight bearing was commenced thereafter. Full movements were regained by three months, in both the hips. A bone scan performed at three months did not show any evidence of avacular necrosis in either femoral head.
A CT scan was not available. On examination three years following the injury, the patient was asymptomatic, and had full movements in both the hips. Radiographs of the hips were normal.
Of all the simultaneous bilateral dislocations of the hip, bilateral posterior dislocations occur in 50% of the cases, bilateral simultaneous anterior and posterior dislocations in 40% of the cases, and bilateral anterior dislocations in the remaining 10% of the cases[3]. Occurrence of anterior hip dislocation, associated with diastasis of the contralateral sacro-iliac joint has been reported as a rear scat passenger injury, by Markharn in 1972[2]. Simultaneous anterior and posterior hip dislocations occurring as an isolated injury, without any major pelvic ring injury is extremely uncommon. Only one case has been reported so far.
The mechanism of injury in this case would appear to be a direct impact on either knee with the hip in flexion and adduction on the right side, causing a posterior dislocation, and flexion adduction and external rotation on the left side, resulting in an anterior dislocation. This peculiar position was adopted by the driver to accommodate himself in the small leg room of a mini car.
The mainstay of treatment in traumatic dislocations of the hip is early reduction, to prevent avascular necrosis of the femoral head, and early active non-weight bearing hip exercise produce an excellent result.
| 1. | Civil IDS, Tapsell PW. Simultaneous anterior and posterior billateral traumatic dislocation of the hips: A case report. Austral NZJ: Surg 1981; 51:542-544.  | | 2. | Markham DE. Anterior dislocation of the hip and diastasis of the contralateral sacro-iliac joint the rear passenger's injury? Brit J Surg 1972; 59:296-298. | | 3. | Marotte JH, Samuel P, Rossin R. Simultaneous bilateral traumatic dislocation of the hip. Report of a case. Rev Chir Orthop 1979; 65:475-476. | | 4. | Sinha SN. Simultaneous anterior and posterior dislocation of the hip joints - A case report. J Trauma 1985; 25: 269-270. | |
