Atypical and unclassifiable hip dislocation with capsule and labrum incarceration: a case report and review of the literature

伴有关节囊和髋臼唇嵌顿的非典型和无法分类的髋关节脱位:病例报告及文献综述

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Abstract

INTRODUCTION AND IMPORTANCE: Hip dislocations excluding the anterior, posterior or central variety have rarely been published. We report an atypical and unclassifiable dislocation of the hip joint with incarceration of the capsule and labrum. The aim of the presentation was to describe an uncommon type of hip dislocation with entrapment of the soft tissue. CASE PRESENTATION: 18-year-old patient, with no specific pathological history, was involved in a road traffic accident causing an unusual right hip joint displacement. After the first reduction, the control X-rays showed persistent enlargement of the joint line, strongly suggesting soft-tissue impingement. Computed tomography confirmed soft tissue entrapment in the anterior area between the head and the acetabulum. An Hueter approach carried out two weeks after the injury, revealed incarceration of the capsule and anterior labrum; which was released and repositioned. At 2-year follow-up, the patient complained of the pain and the Postel Merle d'Aubigné (PMA) score was 17. We observed the peritrochanteric calcifications but without signs of osteonecrosis femoral head. CLINICAL DISCUSSION: Posterior and anterior hip dislocations are the main types. Forms excluding these types have rarely been reviewed. The last ones are usually surgical treatments, which help remove the obstacle, such as soft tissue or a bone fragment. However, the choice of approach depends on the displacement. CONCLUSION: Atypical dislocation of the hip must be carefully reduced, due to the high risk of soft-tissue incarceration. An enlarged joint line on a control X-rays should lead to suspicion of a capsule or labrum interposition and a surgical strategy is required.

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