Double trouble: Testicular dislocation associated with hip dislocation.

Sir,

Traumatic dislocation of testes is a rare injury.[1] It occurs as a result of direct external pressure to perineum, dislocating testis into the surrounding soft tissue. High-energy trauma leading to such injury may also lead to concomitant hip dislocation. To the best of our knowledge, such an association has not been reported.

A 35-year-old male presented to our emergency department with history of road traffic accident. He was riding a motorcycle when he crashed into a stationed truck. He immediately experienced severe pain in his left hip, which he was unable to move. On physical examination, left hip was in attitude of flexion, abduction and external rotation. There was no distal neurovascular deficit.

Radiograph of pelvis showed anterior dislocation of left hip joint into obturator foramen [Figure 1]. The dislocation was immediately reduced under sedation without any difficulty by traction in the line of deformity followed by gentle abduction and internal rotation.

Figure 1

Anteroposterior (AP) radiograph of the pelvis at the time of presentation showing anterior dislocation of left hip

After 2 hrs, the patient complained that his left testis could not be located in scrotum. He was sure that both testes were in normal position, prior to accident. On palpation, there was a tender ovoid mass in left inguinal region. Ultrasound confirmed an empty scrotum and demonstrated left testis in the groin. Closed reduction was performed under general anesthesia and was successful [Figure 2].

Figure 2

Anteroposterior (AP) radiograph of the pelvis after reduction showing congruent reduction of left hip

Testicular dislocation usually results from high-speed motorcycle crashes, with sudden deceleration causing direct straddling of scrotum on saddle.[2] Motorcycle accidents have been identified as one of the most common causes of testicular dislocation.[3] Hip position during trauma defines the direction of dislocation.[45] The position of patients involved in motorcycle accidents makes them more prone for anterior hip dislocation due to the position of leg. Our patient while riding his motorcycle had hit a stationary truck. Due to this sudden impact, there was wide abuction, external rotation and flexion at hip joint leading to anterior hip joint dislocation. These forces also led to the scrotum hitting the seat/fuel tank, which may have caused testicular dislocation.

Diagnosis of testicular dislocation can be made by physical examination when a well-developed but empty scrotal sac is found or an abnormally located testis is palpated. However, other concomitant injuries may preclude disclosure of testicular dislocation. Testicular dislocation can be diagnosed on computed tomography (CT) which reveals empty scrotum or presence of dislocated testis in locations including the inguinal, pubic, penile, perineal, or even intra-abdominal regions. CT or sonography can also reveal testicular dislocation that is masked by severe scrotal edema, hematoma, or associated pelvic injuries.

Once testicular dislocation is diagnosed, early treatment should be instituted. A delay in diagnosis of testicular dislocation may convert manual reduction to surgical orchiopexy with lysis of adhesions and even orchiectomy, with possible deleterious effects of ectopic position.

Traumatic testicular dislocation is frequently associated with other severe injuries such as hip dislocation. Knowledge of such an association by orthopedic surgeon, general surgeon s and emergency medicine physicians will prevent delay in diagnosis. High index of suspicion and thorough physical examination is the key for early diagnosis. Delayed diagnosis or treatment may lead to poor results.