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Jaecker V, Regenbogen S, Märdian S, Brinkema H, Stöckle U, Shafizadeh S. Risk factors and long-term outcomes in anterior iliac and obturator hip dislocation. Eur J Trauma Emerg Surg 2025; 51:205. [PMID: 40380987 DOI: 10.1007/s00068-025-02885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2024] [Accepted: 05/04/2025] [Indexed: 05/19/2025]
Abstract
PURPOSE Traumatic anterior hip dislocation is a severe but poorly studied injury. This study aimed to analyze characteristics, risk factors and prognostic factors regarding long-term morbidity and outcomes in patients who had sustained traumatic anterior hip dislocation. METHODS Demographics, injury mechanism, and treatment-related characteristics of patients with anterior hip dislocations at three level-one trauma centers from 2009-2023 were analyzed. Acetabular and femoral morphology were assessed using CT scans to identify anatomical risk factors. Incidence of avascular necrosis (AVN), post-traumatic osteoarthritis (PTOA), further complications, return to work and sports, and patient-reported outcomes (PROMs), including Tegner Activity Scale (TAS) and modified Harris Hip Score (mHHS) were recorded at the follow-up. RESULTS Out of 196 patients with traumatic hip dislocations, 19 anterior dislocations (12 iliac anterosuperior and 7 obturator) were identified. Ipsilateral knee injuries occurred in 36.8%, and 73.7% had concomitant femoral head or acetabular rim fractures. Obturator dislocations were commonly simple dislocations, while iliac dislocations involved more complex associated fractures often requiring surgery. Acetabular anteversion and cam-type femoroacetabular impingement (FAI) were identified as risk factors. Twelve patients (63%) were available for follow-up (mean 8.33 ± 5.05 years). The majority demonstrated good to excellent mHHS (mean 86.9), and minimal TAS decrease (5.33 to 4.67). AVN was not observed, and only one patient required hip arthroplasty following PTOA. CONCLUSION Anterior hip dislocations commonly result from high-energy "dashboard" injuries, with acetabular anteversion and cam-type FAI morphology being contributing risk factors. Long-term functional outcomes were favorable, with low rates of avascular necrosis or osteoarthritis, independent of type and complexity of the dislocation.
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Affiliation(s)
- Vera Jaecker
- Center for Musculoskeletal Surgery, Charitè - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Department of Trauma and Orthopedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| | - Stephan Regenbogen
- Berufsgenossenschaftliche Unfallklinik Murnau, Department of Traumatology and General Surgery, Professor-Küntscher-Str. 8, 82418, Murnau, Germany
- Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Department of Traumatology, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen Am Rhein, Germany
| | - Sven Märdian
- Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Schillingallee 35, 18057, RostockRostock, Germany
| | - Hanno Brinkema
- Department of Trauma and Orthopedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Ulrich Stöckle
- Center for Musculoskeletal Surgery, Charitè - University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sven Shafizadeh
- Department of Orthopedic Surgery and Sports Traumatology, Witten/Herdecke University, Sana Medical Centre, Aachener Str. 445-449, 50933, Cologne, Germany
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Giannatos V, Antzoulas P, Papathanidis V, Roumeliotis A, Stavropoulos T, Athanasiou V. Anterior hip fracture-dislocation resembling a Hill-Sachs lesion: a case report and review of this special clinical entity. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:182. [PMID: 40343497 DOI: 10.1007/s00590-025-04299-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Accepted: 04/13/2025] [Indexed: 05/11/2025]
Abstract
PURPOSE Anterior hip fracture-dislocation is a rare high energy injury with poor long-term prognosis. A Hill-Sachs-like hip fracture-dislocation is only scarcely described in the literature. CASE We report the case of a 57-year-old suffering an anterior hip fracture-dislocation after a self-inflicted collision with his motorcycle. Knee impaction on the ground with hip abduction and external rotation led to a Hill-Sachs type of lesion in the hip and anterior wall fracture of the acetabulum. Relocation of the hip was possible only under general anesthesia, and gross persistent instability was revealed after reduction. Poor post-operative outcomes by non-operative solutions or ORIF are widely described in the literature, and thus, we performed a total hip arthroplasty in the primary setting, with excellent post-operative outcome in 1-year follow-up and a forgotten joint. CONCLUSION In the rare occurrence of Hill-Sachs-like fracture-dislocation lesion of the hip, we recommend an operative solution in the primary setting, taking into consideration patient's age, intraoperative stability and defect's depth, with total hip arthroplasty being the mainstay of treatment.
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Affiliation(s)
- Vasileios Giannatos
- University of Patras, Pátrai, Greece.
- National and Kapodistrian University of Athens, Athens, Greece.
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Ayoub M, Dorfman E, Burgess M, Martirosian A. Rare Triad of Anterior Hip Dislocation, Greater Trochanter Fracture, and Anterior Acetabulum Fracture: A Report of 2 Cases. JBJS Case Connect 2025; 15:01709767-202506000-00033. [PMID: 40378256 DOI: 10.2106/jbjs.cc.25.00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2025]
Abstract
CASE This report presents 2 extremely rare cases of anterior hip dislocations with associated greater trochanter and acetabular fractures. Both were treated with prompt reduction of the dislocation and open reduction and internal fixation (ORIF) of the greater trochanter fracture. The second patient also underwent ORIF of the acetabulum fracture. Harris Hip Score was 72 at 2.5 years and 95 at 15 years, respectively. CONCLUSION We recommend prompt reduction of the hip dislocation, open reduction and internal fixation of the greater trochanter and acetabular fractures, and addressing any associated articular impaction to optimize functionality and outcomes.
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Tarchichi J, Daher M, Sakr I, Ghoul A, Zalaket J, Ghanem I, Mansour T. Anterior hip dislocation: A current concepts review and proposal of management algorithm. Injury 2024; 55:111252. [PMID: 38043144 DOI: 10.1016/j.injury.2023.111252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
Anterior hip dislocations as compared to posterior, rarely occurs. Nevertheless, it is important to be prepared to manage it. Physical examination and imaging are crucial in detecting this type of dislocation and ruling out any associated fractures. The most important thing is not delaying reduction which is done in a closed manner preferably in the operating room and under general anesthesia. Post-operative complications should be monitored. As for rehabilitation it is still debated and no consensus was reached.
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Affiliation(s)
- Jean Tarchichi
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon.
| | - Mohammad Daher
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
| | - Itala Sakr
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
| | - Ali Ghoul
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
| | - Jad Zalaket
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
| | - Ismat Ghanem
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
| | - Toni Mansour
- Orthopedics Department, Hotel Dieu de France, Beirut, Lebanon
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Makkar D, Sauhta R. Bilateral anterior dislocation in the hips: a case report. JOURNAL OF TRAUMA AND INJURY 2023; 36:70-73. [PMID: 39381672 PMCID: PMC11309207 DOI: 10.20408/jti.2022.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/05/2022] Open
Abstract
The hip is a stable ball-and-socket joint. Bilateral anterior dislocations of the native hip joints account for fewer than 1% of all dislocations. We present a unique case of a bilateral anterior dislocation in a patient who presented to our institution within 6 hours of trauma. The dislocations were promptly reduced under propofol anesthesia in the operating room. The patient did not suffer a concurrent fracture. After the procedure, we performed regular X-ray examinations for 2 years to rule out the development of avascular necrosis of the head of the femur. The course of the patient was unremarkable.
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Affiliation(s)
- Dheeraj Makkar
- Department of Orthopaedics, NC Medical College & Hospital, Panipat, India
| | - Ravi Sauhta
- Department of Orthopaedics, Artemis Hospitals, Gurugram, India
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LaRoque MC, Zeni F, Cole PA. Traumatic Bifocal whereas and Ipsilateral Posterior Knee Dislocation: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00028. [PMID: 36735805 DOI: 10.2106/jbjs.cc.22.00408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CASE A 19-year-old man sustained combined, ipsilateral inferior hip and posterior knee fracture-dislocations secondary to a motor vehicle collision. He underwent immediate closed reduction of the knee and delayed open reduction internal fixation but required emergent open hip reduction for an irreducible femoral head incarcerated on a pubic root fracture. At the 1-year follow-up, he demonstrated excellent functional outcome with painless and full hip and knee range of motion. CONCLUSION Irreducible inferior femoral head dislocation in combination with a knee dislocation requires thoughtful staging and treatment but can result in satisfactory outcomes.
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Affiliation(s)
- Michael C LaRoque
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota
| | - Ferras Zeni
- Allina Health Orthopedics, Minneapolis, St. Paul, Minnesota
| | - Peter A Cole
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota.,HealthPartners Orthopaedics & Sports Medicine, Bloomington, Minnesota
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Joshi PR, Karki S, Timilsina K, Adhikari S, Bhandari PS, Uprety S. Extremely rare combination of open dislocation of the ankle with superior type anterior hip dislocation without bone fracture: A case report. Clin Case Rep 2022; 10:e6467. [PMID: 36267819 PMCID: PMC9576959 DOI: 10.1002/ccr3.6467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/10/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Open dislocation of the ankle without associated fracture is extremely rare. Epstein's superior type of hip dislocation is the rarest type of hip dislocation. We reported a case of 50 years Nepalese gentleman who presented with a combination of these two rare orthopedic emergencies with the newly reported mechanism of injury by a garden tractor. Early extensive debridement of the wound with broad spectrum antibiotics coverage, reduction with delta frame external fixator, and postoperative rehabilitation helps in saving limb along with its function.
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Affiliation(s)
| | | | - Krishna Timilsina
- Department of Orthopedic and Trauma SurgeryTribhuvan University Teaching HospitalKathmanduNepal
| | - Shiris Adhikari
- Department of Orthopedic and Trauma SurgeryTribhuvan University Teaching HospitalKathmanduNepal
| | - Prawesh Singh Bhandari
- Department of Orthopedic and Trauma SurgeryTribhuvan University Teaching HospitalKathmanduNepal
| | - Suresh Uprety
- Department of Orthopedic and Trauma SurgeryTribhuvan University Teaching HospitalKathmanduNepal
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Li WZ, Wang JJ, Ni JD, Song DY, Ding ML, Huang J, He GX. Old unreduced obturator dislocation of the hip: A case report. World J Clin Cases 2021; 9:3979-3987. [PMID: 34141756 PMCID: PMC8180232 DOI: 10.12998/wjcc.v9.i16.3979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/19/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obturator dislocation is a rare type of hip dislocation, accounting for about 2%-5% of all hip dislocations. The occurrence of old unreduced obturator dislocation is even more infrequent, with only 17 cases reported in nine studies, most of which were from the 1950s to 1980s in developing countries.
CASE SUMMARY A 38-year-old woman from Hunan Province, China presented with stiffness of the left hip in abduction, flexion, and external rotation after falling from a 2-meter-tall tree onto her left knee 1.5 mo prior. Pelvic radiograph and computed tomography revealed obturator dislocation of the left hip accompanied by impaction fracture at the superolateral aspect of the left femoral head without associated acetabulum fracture. Open reduction was performed, resulting in restoration of the concentric alignment of the left hip. After surgery, 6-wk skin traction was applied and the patient was kept in bed for an additional 2 wk. At 3 mo after surgery, the patient reported experiencing some pain, which did not affect the function of the affected limb, and some movement restriction but no abduction deformity or claudication was present. An X-ray showed that the left hip was homocentric, and there was no sign of posttraumatic arthritis or avascular necrosis.
CONCLUSION Open reduction may be an effective treatment strategy for the rare condition of old unreduced obturator dislocation with short neglect time.
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Affiliation(s)
- Wen-Zhao Li
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Jun-Jie Wang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Jiang-Dong Ni
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - De-Ye Song
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Mu-Liang Ding
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Jun Huang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Guang-Xu He
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
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