Bilateral traumatic hip dislocation is a rare injury and a bilateral asymmetric pattern is even more rare. Review of the English literature reveals 20 case reports of simultaneous asymmetric hip dislocations. Sixteen of the 20 reported incidents involve motor vehicle accidents. Accordingly, hip dislocations are becoming more frequent as a result of increases in motor vehicle accidents. We report the first female described with traumatic simultaneous asymmetric hip dislocations, as well as the first patient with associated asymmetric acetabular wall fractures.
Motor vehicle accident trauma more frequently involves young males, and males also appear to have a higher percentage of hip injuries compared to females. Studies suggest that male gender, greater height, and reduced femoral anteversion may play a role in this disparity. In general, women have more femoral anteversion and also have more anteverted acetabulums allowing a greater reactive surface to accept femoral load. It is proposed that these anatomical differences may decrease the likelihood of hip injury in females and instead may increase their likelihood to sustain knee or thigh injuries. While the true female-to-male ratio of traumatic simultaneous asymmetric hip dislocations is unknown, this patient is the first female with this injury pattern reported.
The patient's clinical and radiographic findings revealed a “marionette” appearance of the lower extremities. The necessity of prompt treatment requires early clinical recognition of the bilateral asymmetric hip dislocation injury pattern and rapid mobilization of trauma teams. The high incidence of associated injuries necessitates thorough clinical and radio-graphic evaluations. This case report illustrates both that females can sustain this pattern of injury and that unusual associated fracture patterns can occur concomitantly.