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CASE REPORT Table of Contents   
Year : 2005  |  Volume : 39  |  Issue : 3  |  Page : 187-188
Bilateral fracture of neck of femur with bilateral dislocations of hip - A case report


Department of Orthopaedics, General Hospital, ESIS, Ahmedabad, India

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How to cite this article:
Purohit G J. Bilateral fracture of neck of femur with bilateral dislocations of hip - A case report. Indian J Orthop 2005;39:187-8

How to cite this URL:
Purohit G J. Bilateral fracture of neck of femur with bilateral dislocations of hip - A case report. Indian J Orthop [serial online] 2005 [cited 2020 Jan 18];39:187-8. Available from: http://www.ijoonline.com/text.asp?2005/39/3/187/36739

   Introduction Top


Bilateral dislocations of hip is an uncommon injury. Bilateral dislocations of hip with ipsilateral fracture neck of femur is again an extremely rare occurrence [1],[2] . Traumatic bilateral dislocation of hip with bilateral fractures of neck femur has not been reported in literature. We are presenting a two years old neglected case.


   Case Report Top


A 51 year old male presented with history of a severe 'dashboard ' injury in a head on collision of car with a trolley truck sustained two years back. Primarily, he was treated by traction and was adviced surgery for hip injuries which he refused out of fear. He took treatment from local osteopaths in the form of bandages and massage but without any improvement and was bedridden for two years.

On examination, both lower limbs were straight in neutral rotation but no movement in hips, knees or ankle joints. There was no neurological deficit. Posteriorly head of femur were palpable, left side at the level of ischial tuberosity. Hips, knees or ankle were stiff but contraction of quadriceps, tendoachilis and other muscles could be palpated. Both trochanters were overriden.

On radiological examination, a bilateral dislocation of hip with fractures of neck of femur on either side was revealed. The head of left femur was fractured and dislocated out of socket and displaced to the level of ischial tuberosity with new bone formation [Figure - 1]a.

Patient education, awareness program along with extensive physiotherapy of all joints of both lower limbs was started and continued for two weeks without any result. Thereafter, under anaesthesia, bilateral adductor tenotomy along with gentle passive mobilisation of hip, knee and ankle was carried out to get 60 % average ROM under anaesthesia. Active and passive physiotherapy was continued with some improvement in range of movements but hips were not getting abducted. At three weeks, only 40 % range of movement could be achieved which was not satisfactory to perform any surgery and further progress stopped.

So another attempt at bilateral adductor tenotomy with mobilization of all joints of both lower limbs was tried with encouraging result to get 75 to 80 % range of movements under anesthesia. Thereafter, an intense program of physiotherapy resulted in 70 % range of movements in all joints of both lower limbs at the end of three weeks. Then it was decided to under go Charnley's total hip joint replacement surgery on either side.

With patient under spinal anaesthesia in left lateral position, right hip was exposed by posteolateral approach, sciatic nerve was isolated and protected while dissection and removal of head of femur. The neck of femur and acetabular cavity were dissected, and were freed of fibrous contracted tissue. Extensive muscle release was necessary to mobilise the joint. Proper size actabular cup and femoral components were cemented by manual technique. Surgery was somewhat difficult; involving a lot of dissection and release and excision of contracted tissues. Post operatively, gentle active physiotherapy taking care of positioning of joint was started and continued making good recovery without any complications.

After three weeks, surgery of total hip joint replacement was performed in the same manner on left side. The head of femur was found displaced to the level of ischial tuberosity and was adhered to sciatic nerve making dissection and removal of head difficult. Same sizes of implants were used and post-operatively, same regime was continued. There was uneventful recovery on either side.

Patient was made to stand with walker for initial two weeks to get balance as patient had remained bedridden for last two years. After ten days, he could get standing balance and he was gradually encouraged to walk with walker. He was discharged after two weeks of ambulatory training. Rehabilitation exercises were continued at home.

At follow up after six years, patient could walk with stick in one hand. There was mild limp on left side but no pain at all. The range of movements in both hips was 60% of normal and knee and ankles 70 % of normal. He could walk four to five miles without any difficulty. He had to change his occupation to accept sedentary life. He was able to perform his activities of daily living normally and by avoiding sitting cross legged and squatting. Follow up radiological examination show both total hips aligned properly with adequate cementing and no sign of loosening or sinkage [Figure - 1]b.


   Discussion Top


Bilateral hip dislocation is a rare but well recognised condition but bilateral dislocation with fracture of neck of femur on one side is still extremely rare. Only two cases have been reported, one by each surgeon. The mode of injury is usually a 'dashboard' injury in a head on collision.The patient was sitting on the front seat, with his legs crossed with both hips adducted making both hips to dislocate posteriorly by impact on both knees. A more severe impact may have simultaneously fracture the neck of femur on either side.

This case is reported for its unique injury as described as well as for making it a complicated and difficult for treatment by neglecting any sort of active treatment for two years making all joints of both lower limbs completely stiff making any treatment most difficult.



 
   References Top

1.Jain N. Bilateral traumatic posterior dislocation of hip joint with fracture neck of left femur - a case report. Ind J Orthop.1984;18: 38-39.  Back to cited text no. 1    
2. Jain AK. Anterior dislocation of hip and contra lateral posterior disloca­tion hip with fracture neck femur. Ind J Orthop. 1989; 23:193-194.  Back to cited text no. 2    

Top
Correspondence Address:
G J Purohit
Department of Orthopaedics, General Hospital, ESIS, Ahmedabad
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.36739

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    Introduction
    Case Report
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    References
    Article Figures
 

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