Huang K, Giddins G, Zhang JF, Lu JW, Wan JM, Zhang PL, Zhu SY. Asymmetrical traumatic bilateral hip dislocations with hemodynamic instability and an unstable pelvic ring: Case report and review of literature. World J Clin Cases 2018; 6(5): 94-98 [PMID: 29774222 DOI: 10.12998/wjcc.v6.i5.94]
Corresponding Author of This Article
Kai Huang, MD, Attending Doctor, Surgeon, Department of Orthopedics, Tongde Hospital of Zhejiang Province, Gucui Road 234, Hangzhou 310012, Zhejiang Province, China. hzhuangk@163.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Kai Huang, Jian-Fang Zhang, Jian-Wei Lu, Jun-Ming Wan, Peng-Li Zhang, Shao-Yu Zhu, Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
Grey Giddins, Department of Orthopedics, Royal United Hospital Bath, BA1 3NG, United Kingdom
Author contributions: Huang K accountable for the execution of the case report, the integrity and analysis of the data and the writing of the manuscript; Giddins G accountable for the process of analyzing the case and writing the manuscript; Zhang JF accountable for the conception and execution of the case report; Lu JW is the senior author who is the treating surgeon of the patient; Wan JM, Zhang PL and Zhu SY contributed substantially to the process of analyzing the case and writing the manuscript; all authors read and approved the final manuscript.
Supported by Zhejiang Scientific and Technological Plan of Traditional Chinese Medicine, No. 2018ZB033; Zhejiang Medical and Health Science and Technology Project, No. 2018234792.
Informed consent statement: Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. Report of this case is approved by the ethics committee of Tongde Hospital of Zhejiang Province.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kai Huang, MD, Attending Doctor, Surgeon, Department of Orthopedics, Tongde Hospital of Zhejiang Province, Gucui Road 234, Hangzhou 310012, Zhejiang Province, China. hzhuangk@163.com
Telephone: +86-571-89972114 Fax: +86-571-88853199
Received: February 13, 2018 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 Processing time: 92 Days and 5.9 Hours
ARTICLE HIGHLIGHTS
Case characteristics
The patient presented with severe pain in both hips with hemodynamic instability.
Clinical diagnosis
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.
Differential diagnosis
The differential diagnosis included proximal femoral and acetabular fractures. Only investigations primarily radiographs could clarify the diagnosis.
Laboratory diagnosis
The blood tests showed a normal haemoglobin and early inflammatory response which combined with his low blood pressure implied appreciable internal bleeding.
Imaging diagnosis
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.
Pathological diagnosis
Dislocations and fractures.
Treatment
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.
Related reports
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.
Term explanation
MVC: Motor vehicle collision; ORIF: Open reduction and internal fixation.
Experiences and lessons
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.
