Bilateral irreducible asymmetrical fracture-dislocation of the hip: A case report and literature review

INTRODUCTION AND IMPORTANCE: Bilateral hip dislocation is a rare injury. Bilateral asymmetrical fracture-dislocation is an even rarer type of injury. Apart from its rarity, prompt diagnosis of this condition and emergent treatment is necessary to prevent complications. CASE PRESENTATION: Here we present a 32 years old patient admitted with bilateral asymmetrical dislocation of hips following high energy motor traffic accident. CLINICAL FINDINGS AND INVESTIGATIONS: Computed tomography revealed bilateral asymmetrical hip dislocations (Left hip anterior dislocation and the right hip posterior dislocation) with a small femoral head fracture on the right side and a large Pipkin I fracture on the left side. INTERVENTION AND OUTCOME: Closed reduction of bilateral hips failed under general anaesthesia and rendered immediate open reduction of both hips through different approaches and fixation of the osteochondral fragment. Rehabilitation was challenging as the patient has been recovering from a head injury and bilateral lower limb involvement. The patient is under follow-up for any evidence of avascular necrosis of the femoral heads and myositis ossificans. RELEVANCE AND IMPACT: Bilateral irreducible asymmetrical fracture-dislocations of the hip joint are rarest of its kind. Pre-operative emergent computed tomography is very helpful to identify fracture-dislocations and help in the planning of osteosynthesis. Preparation for open reduction while undergoing a close reduction is essential.