Bilateral traumatic hip dislocations—rare injuries typically resulting from high-energy trauma—require prompt recognition and reduction, with delays associated with worse outcomes, according to two case reports and a literature review published in Open Journal of Orthopedics.
Because clinicians often focus on life-threatening injuries in polytrauma settings, one hip may be overlooked, potentially delaying diagnosis and increasing the risk of complications, the researchers noted.
Akawoulou Komla Victore Agbao, of the Department of Orthopaedics & Traumatology, CHU Kara, in Togo, and colleagues described two women with bilateral hip dislocations following road traffic accidents—an uncommon presentation given the male predominance reported in most series.
In the first case, an 18-year-old woman sustained symmetric bilateral high posterior dislocations without associated fracture. Closed reduction was performed under general anesthesia 3 hours following injury. She was treated with one month of skin traction followed by progressive mobilization and protected weight-bearing. At 2 years, she had full range of motion, no pain, and no radiographic evidence of avascular necrosis or early osteoarthritis.
The second case involved a 36-year-old woman with an asymmetric injury pattern consisting of a right posterior acetabular fracture-dislocation and a contralateral obturator dislocation, along with a right patella fracture. Both hips were reduced under general anesthesia less than 2 hours following trauma. Given concentric reduction without obvious intra-articular fragments or gross displacement—and considering resource constraints and patient preference—the acetabular fracture-dislocation was managed nonoperatively with 6 weeks of transosseous condylar traction. The obturator dislocation was treated with 3 weeks of skin traction and physiotherapy. At 11 months, the patient was ambulatory without assistance, with occasional discomfort and maintained joint congruence without evidence of femoral head collapse.
The researchers emphasized that time to reduction is a key prognostic factor. Prior studies suggest that reduction within 6 to 8 hours is associated with a lower risk of femoral head avascular necrosis, whereas delays beyond 12 hours are associated with substantially higher risk.
They also highlighted the role of postreduction imaging. Many authors recommend computed tomography following reduction—particularly in bilateral dislocations—to confirm concentric alignment and detect intra-articular fragments or occult fractures not visible on plain radiographs. Some have suggested that bilateral hip dislocation in polytrauma may warrant whole-body computed tomography to avoid missing associated injuries.
Treatment decisions depend on associated fractures and reduction stability. While acetabular fracture-dislocations are often managed surgically, the researchers noted that nonoperative approaches may be appropriate in selected cases with stable, concentric reduction and no evidence of intra-articular fragments.
These findings have important limitations. The report included only two patients, follow-up was limited—particularly in the fracture-dislocation case—and standardized functional outcome measures such as the Harris Hip Score were not collected. Longer-term risks, including avascular necrosis and post-traumatic osteoarthritis, may not become apparent for several years.
“These two cases illustrate the diversity and severity of bilateral traumatic hip dislocations,” Agbao and colleagues wrote. “They underline the need to systematically assess both hips in any high-energy pelvic trauma and to perform prompt reduction.”
The researchers reported no conflicts of interest.
Source: Open Journal of Orthopedics