BILATERAL TRAUMATIC HIP DISLOCATION: SYSTEMATIC REVIEW AND REPORT OF A RARE CASE OF BILATERAL ANTERIOR HIP DISLOCATION

Abstract

Background: Bilateral hip dislocations are rare injuries with asymmetric dislocation being the commonest type. Bilateral anterior hip dislocation and bilateral posterior hip dislocation are even rarer. Due to the paucity of cases, there are few literature reviews
critically evaluating various aspects of bilateral hip dislocation.
Methods: In this study, a case of post-traumatic bilateral anterior hip dislocation was presented. A detailed literature search of PUBMED, MEDLINE and EMBASE and the corresponding backreference were done. The articles were then systematically
evaluated for incidence, mechanism of injury, associated injuries, treatments, and outcome of bilateral hip dislocations.
Results: A total of reported 110 asymmetric dislocations, 19 bilateral anterior hip dislocations and 17 bilateral posterior hip dislocations were evaluated. Obturator type was the most common variety among the bilateral anterior hip dislocations and anterior
components of asymmetric dislocations. The bilateral anterior hip dislocation was most probably due to sudden relative forward movement of the pelvis while both hips were in flexion, abduction and external rotation. Whereas in bilateral posterior hip
dislocation the mechanism may be multifactorial, and asymmetric dislocation may be due to two different dislocations occurring in quick succession or due to asymmetric positioning of the hips during the impact. While hip injuries (femoral head and neck
fractures) were common among bilateral posterior hip dislocation (43.7%), acetabular fractures and other skeletal and non-skeletal injuries were more frequent in asymmetric dislocation (44%) indicating a higher degree of initial impact in these dislocations. Conclusion: Bilateral hip dislocations are rare injuries and may be associated with other skeletal or systemic injuries. The presence of associated acetabular or femoral head fracture significantly increases the risk of poorer outcome. Bilateral anterior hip dislocations have lesser associated injuries and better outcomes in comparison to other types.