Case Report

Luxatio Erecta of the Hip- A Report of Five Cases and the

Literature Review
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Ganesh Singh Dharmshaktu, Navneet Adhikari, Binit Singh

Department of Orthopedics, Government Medical College, Haldwani, Uttarakhand, India
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Abstract
Hip dislocation is a serious injury which most commonly presents as posterior dislocation. Inferior dislocation is a rare event with a few
anecdotal case reports or series described in the literature. This has also been called luxatio erecta of the hip borrowing from similar affliction
at shoulder. We report five cases of luxatio erecta of the hip managed by reduction and conservative care in all but one. All five cases were
males (mean age 31.8 years, range 18–52 year) with three cases being isolated injuries, whereas associated fracture of ipsilateral superior
ramus and shaft femur was found in two separate cases. All were managed conservatively following closed reduction, except the case with
shaft femur that was managed by additional operative fixation following the reduction of hip. The results were excellent in all cases without
radiological evidence of avascular necrosis during the mean follow‑up of 7.6 months (range 4–10 months).

Keywords: Closed reduction, hip dislocation, inferior dislocation, injury, obturator dislocation

Introduction movements. The radiographs showed inferior dislocation of

Anterior dislocation of the hip is less commonly encountered
than posterior dislocations, with a reported incidence of only
10% of hip dislocations.[1] Anterior dislocation is mostly an
inferior one, whereas superior dislocations are rare. Anterior
inferior dislocation, also known as obturator dislocation, is
the most common presentation. Luxatio erecta is the term
commonly used to describe inferior shoulder dislocation and
similar affliction in the hip region, suggesting that inferior
dislocation of the hip is described as luxatio erecta of the hip
or luxatio erecta femoris.[2] Although it is no authentic medical
terminology, it has literary appeal. This is a rare injury and is
limited to few case reports or small series the literature.
Case Reports
Case 1
A 27‑year‑old male patient presented to us following an injury
while riding the bike as his bike fell into a gorge and his left
lower extremity got stuck in the bike. The stuck extremity made
his hip hyperflexed against the seat as the bike hit the ground.
There were deformity and pain on the left hip region, and he
could not bring the affected lower extremity to the midline.
The limb was abducted with painful restriction of passive
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the left hip without any other associated injury [Figure 1a].
The dislocation was reduced under sedation by manual
traction in the line of deformity to start with followed by
adduction of thigh, leading to uneventful clinical reduction.
The radiographs confirmed concentric reduction, and rest of
3 weeks was advised along with nonweight‑bearing in affected
extremity [Figure 1b]. Gradual supervised physiotherapy was
done for functional recovery in the follow‑up of 8 months.
There was no limitation of motion or features of avascular
necrosis (AVN) in the radiographs.
Case 2 and 3
A 52‑year‑old male and a 36‑year‑old male had a history of
fall from cliff in separate incidents, leading to injury over the
left and right lower extremities, respectively. The painful hip
and abducted and flexed hip suggested hip dislocation, and the
Address for correspondence: Dr. Ganesh Singh Dharmshaktu,
Department of Orthopedics, Government Medical College, Haldwani,
Uttarakhand, India.
E‑mail: drganeshortho@gmail.com
Received : 12‑01‑2020 Revised : 15-03-2020
Accepted : 15-03-2020 Published Online : ***
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For reprints contact: reprints@medknow.com

DOI: How to cite this article: Dharmshaktu GS, Adhikari N, Singh B. Luxatio
10.4103/JODP.JODP_2_20 erecta of the hip- A report of five cases and the literature review. J Orthop
Dis Traumatol 2020;3:XX-XX.

© 2020 Journal of Orthopaedic Diseases and Traumatology | Published by Wolters Kluwer - Medknow 13
 Dharmshaktu, et al.: Luxatio erecta hip
radiographs confirmed isolated inferior hip dislocation in each
case [Figure 2a and c]. Both were managed similar to Case 1,
leading to clinicoradiological reduction under sedation coupled
with concentric reduction on radiographs [Figures 2b and d].
The follow‑up of both cases was 4 and 7 months, respectively,
and no signs of AVN could be seen on radiology.
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Case 4
A 26‑year‑old male patient presented with fall of wall over him,
leading to injuries to his chest, head, and right lower extremity.
There was blunt chest trauma with the sixth and seventh rib
fracture, and head injury was not serious. The lower extremity
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was painfully held in flexed and abducted. The radiograph
showed isolated inferior hip dislocation along with minimal
displaced ipsilateral superior pubic ramus fracture [Figure 3a].
The patient was managed with in‑line traction and gradual
adduction, leading to an uneventful concentric reduction under
sedation which was confirmed on radiographs [Figure 3b].
The superior pubic ramus had uneventful course till union
at 5 months. The total follow‑up period in this case was
10 months.
Case 5
An 18‑year‑old adolescent male was injured in a road traffic
accident while the vehicle fell into the gorge, and the patient
could not ascertain the position of limbs and other details of
injury due to history of transient altered level of consciousness
but without serious head injury. There was abducted left lower
limb with deformity at upper thigh along with additional
b c
Figure 1: Radiograph showing inferior dislocation of left hip without
other pelvic injury (a). The postreduction radiograph showing concentric
reduction (b)
14 Journal of Orthopaedic Diseases and Traumatology ¦ Volume 3 ¦ Issue 1 ¦ January-April 2020
abnormal mobility, suggesting fracture of the femur. The
radiographs confirmed fracture of the shaft of the femur
along with ipsilateral inferior hip dislocation [Figure 4a].
The patient was taken to operation and the dislocation was
reduced with help of percutaneous Schanz pin insertion in the
proximal fragment and gentle traction under anesthesia. After
the relocation, antegrade femur nailing was done and final
reduction of the fracture and that of hip joint were confirmed
on fluoroscopy [Figure 4b and c]. The radiographs showed
concentric reduction of hip and satisfactory implant position.
Fracture united in the course of 5 months, and the patient had
painless ambulation and movements without radiological AVN
at follow‑up of 9 months.
Discussion
The anterior inferior dislocation or the obturator dislocation
has characteristic limb position and mechanism of injury.
Kolar et al. suggested that extreme hip flexion coupled with
lateral pressure might make head of the femur pushed through
gap between ischiofemoral and pubofemoral ligaments with
iliofemoral ligament acting as hinge.[3] The typical mechanism
of injury is usually not remembered by patients, but one is
continued force over an abducted flexed thigh that is externally
rotated and levering out of femoral head out of acetabulum. The
other presentation is inverted femur lying below acetabulum.[4]
Axial load on flexed or abducted femur is usual mode of injury,
leading to inferior dislocation in cases of fall from height like
that in our first case.[5,6] A similar injury to our second case
was described in a 17‑year‑old male with associated femur
head and neck and contralateral shaft femur fracture that
was managed by open reduction.[6] Very few cases of inferior
dislocation and concomitant femur fractures are described in
the literature, thus making this combination a rare pattern.[7,8]
One case of vertical fracture of the femoral head was associated
with this injury that required open reduction for its fixation.[9]
One case, however, of greater trochanter fracture postreduction
a b
d
Figure 2: The radiographs of inferior dislocations of the left hip
before (a) and after reduction (b). Another case with the right side inferior
dislocation before (c) and after (d) the concentric reduction
 Dharmshaktu, et al.: Luxatio erecta hip

is reported in the literature.[10] In one rare case, open injury
of inferior dislocation was reported and managed by open
reduction after failed closed attempt.[11] There is possibility of
getting neglected inferior dislocation, and one case in a child
has been reported that was managed surgically.[12] There is
only one case of rare bilateral inferior dislocation reported in
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recent literature.[13] Most of the dislocation has been managed
by closed techniques, but at times, open reduction is the next
option.[14] The results of the dislocation in most studies have
been found good with good range of motion and no features of
AVN in most reports.[15,16] A relevant point of recently reported
open access cases is given in tabulated form [Table 1]. All

Table 1: Relevant details of cases of inferior obturator dislocation in recent literature in chronological sequence
Authors Age/sex Affected side Associated injury Reduction details Postreduction Result
Singh et al., Ipsilateral IT fracture
Reduction with Schanz 2.5 years, normal
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2006[7] screw in T handle, ROM, no AVN

DHS for IT fracture
Singh et al., 55/male Right Ipsilateral open ST Reduction with Schanz Traction for 2 weeks 2 years, ROM
2008[8] fracture screw, Ex Fix for ST followed by comparable to normal
fracture mobilization hip side, No AVN
Kolar et al., 37/male Right Pins and needles Gentle traction No mention 1 year, active without
2011[3] following by numbness and extension, i/v sports participation
right foot midazolam
Bhagwat et al., 30/male B/L None Reduction under Skin traction for 6 months, no residual
2012[13] sedation 6 weeks deformity
Aggarwal et al., Four male Right in three Head and chest injury Reduction in GA in Skin traction for Average 6 months, no
2012[2] patients aged and left in one in one case each three and in sedation 6 weeks residual deformity
40, 56, 29, and case in one
10 years
Yang et al., 47/male Right Post reduction GT GA Bed rest 3 weeks 2 years, full pain‑free
2014[10] fracture fixed with and crutch walk next ROM
implant 3 weeks
Cho 2014[9] 27/male Right Ipsilateral femoral None Closed reduction 1 year, union of fracture
head fragment within done followed by and no AVN
joint ORIF of femoral
head with screw
Zeytin et al., 55/male Left None Sedation analgesia No mention No mention
2015[15] with fentanyl,
midazolam
Jain et al., 2015[6] 17/male Right Ipsilateral femur head ORIF NWB 6 week 4‑year full ROM. Mild
and neck, contralateral HO
femur shaft
Gebreslassie 10/female Right Neglected injury Open reduction Skin traction for 10 months, no AVN,
2015[12] 86 days old 3 weeks good ROM
Tekin et al., 26/female Left Fracture ribs, wrist, Sedo‑analgesia No mention No mention
2016[5] clavicle, dorsolumbar
spine and chest injury
El Hajj Moussa 24/male Right Mild pneumothorax GA Bed rest 6 week 3 months, full
et al., 2016[4] as CT showed weight bearing, no
undisplaced head and complication
IT fracture
Ismael et al., 17/male Right Ipsilateral fractures Closed reduction Immobilize 6 weeks 3 months, no
2017[14] of radius ulna and under GA failed re‑dislocation and AVN
left femur. Splenic, followed by open
mandible and chest reduction
injury
Esmailiejah 8/male Right Pelvic ring disruption Open reduction along Upper tibial skeletal 9 month, mild
et al., 2017[11] and ipsilateral open open wound traction 2 week, irregularity head but
distal femur fracture, spica 4 weeks nonprogressive. 6‑year
all fixed in stages follow‑up normal ROM
and gait
Kulambi et al., 30/male Right None GA Thomas splint 6‑month, pain‑free
2018[16] 3 weeks, partial normal ROM, no AVN
weight‑bearing
3 weeks
B/L: Bilateral, IT: Intertrochanteric, ST: Sub‑trochanteric, DHS: Dynamic hip screw, i/v: Intravenous, ROM: Range of motion, AVN: Avascular necrosis,
EX Fix: External fixator, ORIF: Open reduction internal fixation, NWB: Nonweight‑bearing, HO: Heterotopic ossification, GT: Greater trochanter,
GA: General anesthesia

Journal of Orthopaedic Diseases and Traumatology ¦ Volume 3 ¦ Issue 1 ¦ January-April 2020 15

 Dharmshaktu, et al.: Luxatio erecta hip
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a
b J Traumatol 2012;15:317‑20.
Figure 3: The radiograph showing right inferior obturator dislocation
along with ipsilateral superior pubic ramus fracture (a) and the hip and
the fracture are well reduced after the closed reduction (b)
b in an adult with ipsilateral trochanteric fracture. J Orthop Trauma
a c
Figure 4: The radiograph showing left‑sided inferior dislocation in an
adolescent with ipsilateral shaft femur fracture (a) that was managed
operatively with reduction of dislocation followed by femur nailing(b and c)
our cases were also managed conservatively except that with
shaft femur. The follow‑up was short in our cases, but clinical
and radiological results were good in all. These rare injuries
need anticipatory knowledge and reduction methods for
better management. Associated injuries are common and need
exclusion with this injury pattern. More cases or preferably
16 Journal of Orthopaedic Diseases and Traumatology ¦ Volume 3 ¦ Issue 1 ¦ January-April 2020
multicenter studies resulting in large case pool are required to
know their mechanism of injury and long‑term complications
apart from gaining insights to draft treatment guidelines.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and other
clinical information to be reported in the journal. The patients
understand that their names and initials will not be published
and due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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