Inferior Hip Dislocation with Luxatio Erecta

Motorcycle Collision • Xray of the Week

23 y.o. male with left hip pain after motorcycle collision. What is the diagnosis? What to do next?

Figure 1. Frontal and lateral left hip radiographs.

Figure 2. Annotated frontal and lateral left hip radiographs. On the frontal view, the femoral head is dislocated inferiorly (red arrow) and the shaft of the femur is foreshortened. On the lateral view, the hip is in fixed flexion also known as luxatio erecta (yellow arrow).

Figure 3. Post-reduction CT scan of pelvis and left hip. There is a fracture fragment in the joint posteriorly (red arrow). On the coronal images, note the joint widening (green arrow) and the donor site of the intra-articular fragment from the inferior acetabulum (yellow arrow).

Video: 3D CT scan of Inferior Hip Dislocation with Luxatio Erecta in a different patient.

Discussion

Inferior hip dislocation is the rarest type of hip dislocation and is seen in high energy trauma with force applied to an abducted, flexed thigh that is externally rotated. Luxatio erecta, a term used predominantly for inferior shoulder dislocation, refers to the flexion deformity that is a result of the of the femoral head resting inferior to the acetabulum and lateral to the ischial tuberosity. Postreduction CT scan is required as associated injuries are very common and as in this case are often not visualized on the plain radiographs. General anesthesia is usually needed for reduction, which should be performed as soon as possible since delays may lead to avascular necrosis.

References: 1. Moussa ME, Tawk C, Hoyek F, et al. Traumatic inferior hip dislocation: a rare adult case with ipsilateral bifocal hip fracture. J Surg Case Rep. 2016 Apr; 2016(4): rjw056. doi: https://dx.doi.org/10.1093/jscr/rjw056

2. Ismael S, Vora J, Thomas P. Adult Traumatic Inferior Hip Dislocation: Rare Case Ended with Open Reduction. J Orthop Case Rep. 2017 Jan-Feb; 7(1): 101–104. doi: 10.13107/jocr.2250-0685.708

3. Tekin AC, Çabuk H, Büyükkurt CD, et al. Inferior hip dislocation after falling from height: A case report. Int J Surg Case Rep. 2016; 22: 62–65. doi: 10.1016/j.ijscr.2016.02.041

4. Jain S., Haughton B.A., Grogan R.J. Inferior dislocation of the hip: a case report and literature review. J. Orthop. Surg. (Hong Kong) 2015;23(April (1)):123–126.

5. Brogdon BG, Woolridge DA. Luxatio erecta of the hip: a critical retrospective. Skeletal Radiol 1997;26:548–52.

Kevin M. Rice, MD is president of Global Radiology CME and serves as the Chief of Staff and Chair of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. Dr. Rice co-founded Global Radiology CME with Natalie Rice to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" award for the Most Effective Radiology Educator.

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