|Year : 2020 | Volume
| Issue : 1 | Page : 13-16
Luxatio erecta of the hip- A report of five cases and the literature review
Ganesh Singh Dharmshaktu, Navneet Adhikari, Binit Singh
Department of Orthopedics, Government Medical College, Haldwani, Uttarakhand, India
|Date of Submission||12-Jan-2020|
|Date of Decision||15-Mar-2020|
|Date of Acceptance||15-Mar-2020|
|Date of Web Publication||30-Apr-2020|
Ganesh Singh Dharmshaktu
Department of Orthopedics, Government Medical College, Haldwani, Uttarakhand
Source of Support: None, Conflict of Interest: None
Hip dislocation is a serious injury which most commonly presents as posterior dislocation. Inferior dislocation is a rare event with a few anecdotal case reports or series described in the literature. This has also been called luxatio erecta of the hip borrowing from similar affliction at shoulder. We report five cases of luxatio erecta of the hip managed by reduction and conservative care in all but one. All five cases were males (mean age 31.8 years, range 18–52 year) with three cases being isolated injuries, whereas associated fracture of ipsilateral superior ramus and shaft femur was found in two separate cases. All were managed conservatively following closed reduction, except the case with shaft femur that was managed by additional operative fixation following the reduction of hip. The results were excellent in all cases without radiological evidence of avascular necrosis during the mean follow-up of 7.6 months (range 4–10 months).
Keywords: Closed reduction, hip dislocation, inferior dislocation, injury, obturator dislocation
|How to cite this article:|
Dharmshaktu GS, Adhikari N, Singh B. Luxatio erecta of the hip- A report of five cases and the literature review. J Orthop Dis Traumatol 2020;3:13-6
|How to cite this URL:|
Dharmshaktu GS, Adhikari N, Singh B. Luxatio erecta of the hip- A report of five cases and the literature review. J Orthop Dis Traumatol [serial online] 2020 [cited 2020 Aug 13];3:13-6. Available from: http://www.jodt.org/text.asp?2020/3/1/13/283677
| Introduction|| |
Anterior dislocation of the hip is less commonly encountered than posterior dislocations, with a reported incidence of only 10% of hip dislocations. Anterior dislocation is mostly an inferior one, whereas superior dislocations are rare. Anterior inferior dislocation, also known as obturator dislocation, is the most common presentation. Luxatio erecta is the term commonly used to describe inferior shoulder dislocation and similar affliction in the hip region, suggesting that inferior dislocation of the hip is described as luxatio erecta of the hip or luxatio erecta femoris. Although it is no authentic medical terminology, it has literary appeal. This is a rare injury and is limited to few case reports or small series the literature.
| Case Reports|| |
A 27-year-old male patient presented to us following an injury while riding the bike as his bike fell into a gorge and his left lower extremity got stuck in the bike. The stuck extremity made his hip hyperflexed against the seat as the bike hit the ground. There were deformity and pain on the left hip region, and he could not bring the affected lower extremity to the midline. The limb was abducted with painful restriction of passive movements. The radiographs showed inferior dislocation of the left hip without any other associated injury [Figure 1]a. The dislocation was reduced under sedation by manual traction in the line of deformity to start with followed by adduction of thigh, leading to uneventful clinical reduction. The radiographs confirmed concentric reduction, and rest of 3 weeks was advised along with nonweight-bearing in affected extremity [Figure 1]b. Gradual supervised physiotherapy was done for functional recovery in the follow-up of 8 months. There was no limitation of motion or features of avascular necrosis (AVN) in the radiographs.
|Figure 1: Radiograph showing inferior dislocation of left hip without other pelvic injury (a). The postreduction radiograph showing concentric reduction (b)|
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Case 2 and 3
A 52-year-old male and a 36-year-old male had a history of fall from cliff in separate incidents, leading to injury over the left and right lower extremities, respectively. The painful hip and abducted and flexed hip suggested hip dislocation, and the radiographs confirmed isolated inferior hip dislocation in each case [Figure 2]a and [Figure 2]c. Both were managed similar to Case 1, leading to clinicoradiological reduction under sedation coupled with concentric reduction on radiographs [Figure 2]b and [Figure 2]d. The follow-up of both cases was 4 and 7 months, respectively, and no signs of AVN could be seen on radiology.
|Figure 2: The radiographs of inferior dislocations of the left hip before (a) and after reduction (b). Another case with the right side inferior dislocation before (c) and after (d) the concentric reduction|
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A 26-year-old male patient presented with fall of wall over him, leading to injuries to his chest, head, and right lower extremity. There was blunt chest trauma with the sixth and seventh rib fracture, and head injury was not serious. The lower extremity was painfully held in flexed and abducted. The radiograph showed isolated inferior hip dislocation along with minimal displaced ipsilateral superior pubic ramus fracture [Figure 3]a. The patient was managed with in-line traction and gradual adduction, leading to an uneventful concentric reduction under sedation which was confirmed on radiographs [Figure 3]b. The superior pubic ramus had uneventful course till union at 5 months. The total follow-up period in this case was 10 months.
|Figure 3: The radiograph showing right inferior obturator dislocation along with ipsilateral superior pubic ramus fracture (a) and the hip and the fracture are well reduced after the closed reduction (b)|
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An 18-year-old adolescent male was injured in a road traffic accident while the vehicle fell into the gorge, and the patient could not ascertain the position of limbs and other details of injury due to history of transient altered level of consciousness but without serious head injury. There was abducted left lower limb with deformity at upper thigh along with additional abnormal mobility, suggesting fracture of the femur. The radiographs confirmed fracture of the shaft of the femur along with ipsilateral inferior hip dislocation [Figure 4]a. The patient was taken to operation and the dislocation was reduced with help of percutaneous Schanz pin insertion in the proximal fragment and gentle traction under anesthesia. After the relocation, antegrade femur nailing was done and final reduction of the fracture and that of hip joint were confirmed on fluoroscopy [Figure 4]b and [Figure 4]c. The radiographs showed concentric reduction of hip and satisfactory implant position. Fracture united in the course of 5 months, and the patient had painless ambulation and movements without radiological AVN at follow-up of 9 months.
|Figure 4: The radiograph showing left-sided inferior dislocation in an adolescent with ipsilateral shaft femur fracture (a) that was managed operatively with reduction of dislocation followed by femur nailing(b and c)|
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| Discussion|| |
The anterior inferior dislocation or the obturator dislocation has characteristic limb position and mechanism of injury. Kolar et al. suggested that extreme hip flexion coupled with lateral pressure might make head of the femur pushed through gap between ischiofemoral and pubofemoral ligaments with iliofemoral ligament acting as hinge. The typical mechanism of injury is usually not remembered by patients, but one is continued force over an abducted flexed thigh that is externally rotated and levering out of femoral head out of acetabulum. The other presentation is inverted femur lying below acetabulum. Axial load on flexed or abducted femur is usual mode of injury, leading to inferior dislocation in cases of fall from height like that in our first case., A similar injury to our second case was described in a 17-year-old male with associated femur head and neck and contralateral shaft femur fracture that was managed by open reduction. Very few cases of inferior dislocation and concomitant femur fractures are described in the literature, thus making this combination a rare pattern., One case of vertical fracture of the femoral head was associated with this injury that required open reduction for its fixation. One case, however, of greater trochanter fracture postreduction is reported in the literature. In one rare case, open injury of inferior dislocation was reported and managed by open reduction after failed closed attempt. There is possibility of getting neglected inferior dislocation, and one case in a child has been reported that was managed surgically. There is only one case of rare bilateral inferior dislocation reported in recent literature. Most of the dislocation has been managed by closed techniques, but at times, open reduction is the next option. The results of the dislocation in most studies have been found good with good range of motion and no features of AVN in most reports., A relevant point of recently reported open access cases is given in tabulated form [Table 1]. All our cases were also managed conservatively except that with shaft femur. The follow-up was short in our cases, but clinical and radiological results were good in all. These rare injuries need anticipatory knowledge and reduction methods for better management. Associated injuries are common and need exclusion with this injury pattern. More cases or preferably multicenter studies resulting in large case pool are required to know their mechanism of injury and long-term complications apart from gaining insights to draft treatment guidelines.
|Table 1: Relevant details of cases of inferior obturator dislocation in recent literature in chronological sequence|
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]