Traumatic Asymmetrical Bilateral Hip Dislocation with Associated Acetabular Posterior Column Fracture: A Rare and Complex Orthopaedic Case Report

Abstract

Introduction: Traumatic hip dislocation is an orthopedic emergency that usually results from high-energy trauma. Bilateral hip dislocations are rare, and asymmetrical bilateral dislocations, in which one hip is dislocated posteriorly and the other anteriorly, are even more uncommon. When accompanied by acetabular fractures, these injuries become particularly complex and require prompt diagnosis and multidisciplinary management to optimize outcomes. Case Presentation: A 40-year-old man presented with severe bilateral hip pain and inability to move both lower limbs after being struck by a fallen tree during a logging accident, representing a high-energy trauma mechanism with multidirectional force transmission. Clinical examination showed deformity of both lower extremities. Initial pelvic radiographs revealed asymmetrical bilateral hip dislocation, consisting of posterior dislocation of the right hip and anterior dislocation of the left hip. Further evaluation with pelvic computed tomography, including multiplanar reconstruction, confirmed an elementary posterior column fracture of the right acetabulum according to the Judet-Letournel classification, without associated femoral head injury. Closed reduction under sedation was successfully performed for both hips, followed by skeletal traction on the right side and skin traction on the left side. Definitive surgical management of the right acetabular fracture was subsequently performed with open reduction and internal fixation through a Kocher-Langenbeck approach using straight non-locking reconstruction plates. In the early postoperative period, the patient remained hemodynamically stable, with controlled pain, intact neurovascular status, preserved distal limb function, and initiation of early rehabilitation. Conclusion: This case highlights the rarity and complexity of asymmetrical bilateral traumatic hip dislocation associated with a posterior column acetabular fracture. Early recognition, detailed imaging with radiographs and computed tomography, prompt reduction, CT-based fracture characterization, timely anatomical fixation, and multidisciplinary postoperative rehabilitation are essential for favorable short-term outcomes. Given the scarcity of reported cases, further studies and additional case reports are needed to better define optimal management strategies and long-term functional outcomes.