Treatment of inveterate traumatic obturator-type anterior hip dislocation with closed reduction. Case Report

Abstract

Introduction: Anterior obturator-type hip dislocation is a rare condition, accounting for approximately 5% of all hip dislocations. Timely treatment reduces the risk of short- and long-term complications such as necrosis of the femoral head. When this injury is inveterate, in other words, when it has not been reduced within the first three weeks of its occurrence, it is usually treated by open reduction.

Case presentation: A 43-year-old man presented to the emergency room of a tertiary care center in Cali (Colombia) due to pain in the left hip and functional limitation secondary to high-energy trauma to the left hip 20 days prior to the visit. Physical examination showed apparent elongation of the left leg, while X-ray and computed tomography (CT) scan with three-dimensional reconstruction of the left hip on admission showed an anterior obturator dislocation (type 1B based on the modified Yaari classification). Given the imaging findings and the patient's financial situation, a closed reduction was performed (Allis maneuver with subsequent lateral skin traction in the proximal third of the thigh), achieving adequate functional outcomes. The patient, of his own volition, was discharged the following day, walking without the need for support devices or evidence of pain. Unfortunately, he did not attend follow-up appointments.

Conclusions: Although the treatment of inveterate obturator-type anterior hip dislocation usually involves surgery, from the experience of the reported case it may concluded that closed reduction is a suitable treatment option to be considered in contexts of low socioeconomic resources or in patients who cannot be taken to surgery, as it implies a lower functional and, therefore, financial impact, and its use in the reported patient allowed obtaining a satisfactory outcome.