Published online May 16, 2018. doi: 10.12998/wjcc.v6.i5.94
Peer-review started: February 13, 2018
First decision: March 8, 2018
Revised: April 1, 2018
Accepted: April 16, 2018
Article in press: April 17, 2018
Published online: May 16, 2018
The patient presented with severe pain in both hips with hemodynamic instability.
On examination his right lower limb was flexed, adducted, and internally rotated, his left lower limb was flexed, abducted and externally rotated; he was hemodynamically unstable.
The differential diagnosis included proximal femoral and acetabular fractures. Only investigations primarily radiographs could clarify the diagnosis.
The blood tests showed a normal haemoglobin and early inflammatory response which combined with his low blood pressure implied appreciable internal bleeding.
Radiographs showed asymmetrical dislocations of both hips, with the left hip dislocated anteriorly and the right hip dislocated posteriorly; computed tomography imaging also showed a longitudinal sacral fracture and left superior pubis ramus fracture.
Dislocations and fractures.
He was given circulatory support with intravenous fluids and a blood transfusion, and rapid stabilization of his pelvic ring and arterial embolization to reduce haemorrhage.
Only 33 cases of asymmetrical bilateral hip dislocations have been previously reported in the English language literature. Although they were all due to high-energy injuries, they were hemodynamically stable and had a stable pelvic ring. We report a unique case of asymmetrical hip dislocations with an unstable pelvic ring and hemodynamic instability.
MVC: Motor vehicle collision; ORIF: Open reduction and internal fixation.
Given the severity of the associated complications, every effort should be made to ensure prompt diagnosis and immediate therapy. Attention must be paid to resuscitation, including initial circulation support, reduction of bleeding through pelvic stabilization and arterial embolization and subsequent joint reduction and fracture stabilization.