Bilateral asymmetric hip dislocation: A case series and literature review of a rare injury pattern.

BACKGROUND: Bilateral asymmetric hip dislocation, with one hip dislocated posteriorly and with anterior dislocation of the contralateral hip, is a rare injury pattern. A total of 34 cases have been reported in English literature, but only 24 cases detail injury mechanism and patient demographic factors, 3 of which reported bilateral asymmetric hip dislocation in female patients. Only one report describes more than one example. We describe four patients with bilateral asymmetric hip dislocation, including one example in a female patient, which represents the largest case series to date. Pertinent anatomy, injury mechanism, treatment options, and prognosis are also discussed.
METHODS: A literature review was conducted via PubMed using the term bilateral asymmetric dislocation. Review of additional reports cited by articles found by our search resulted in what we think to be an exhaustive list of cases reported to date.A medical record review of four patients treated at our institution, a Level I trauma center, was performed to compare our treatment methods and outcomes to those previously described.
RESULTS: All four patients in our case series had satisfactory outcomes. Motor vehicle collision is the most common cause of bilateral asymmetric hip dislocation.
CONCLUSION: Timely, accurate reduction of bilateral asymmetric hip dislocation is recommended for optimal outcomes. An understanding of pertinent anatomy about the hip joint allows the orthopedic surgeon to perform a safe, timely reduction. In the absence of an associated acetabular fracture, conservative management with weight-bearing restrictions typically leads to good outcomes without complications such as aseptic necrosis of the femoral head. LEVEL OF EVIDENCE: Therapeutic study, level V.