Introduction: Inferior dislocation of the hip, also called luxatio erecta femoris, is the rarest type of hip dislocation with a poorly understood mechanism of injury. We came across three such cases resulting from high-energy trauma with various other associated injuries.
Case Report: The first patient, a 25-year-old man, presented with the right hip pain, hip and knee joint in flexion without rotational component, after motor vehicle collision. The second patient, a 42-year-old man, presented with the left hip pain, hip and knee joint in flexion with rotational component, following fall from 20 ft height. The third patient, a 29-year-old lady, presented with the left hip pain, hip and knee joint in flexion with rotational component, after motor vehicle collision. All three patients were diagnosed by radiograph and were managed by closed reduction under short general anesthesia, within 3 h, 9 h, and 6 h, respectively. Thomas splint was used to immobilize the limb in all for 1 month and weight-bearing was started after 2 months from injury. Two of them were followed up to 6 months and one was lost to follow up. No evidence of avascular necrosis of femoral head or other complication related to hip dislocation was noted.
Conclusion: Luxatio erecta femoris is a rare type of hip dislocation and with limited publication. The position of limb on presentation should raise the suspicion of same and diagnosis confirmed through radiological investigations. Usually, this type of dislocation can be managed with closed reduction. If closed reduction is unsuccessful, then a fracture femur or bone chip in the joint could be the cause of the difficulty.
Keywords: Hip, dislocation, inferior, luxatio erecta femoris.
To compare the results of high tibial osteotomy with partial fibulectomy in the surgical management of isolated medial compartment osteoarthritis of knee and to reduce pain and deformity. Methods: patients visiting the outpatient department of S.C.S.M.S.R. with complaints of knee pain. Patients who were found to have isolated medial compartment osteo-arthritis will be included in the study. 50 patients were subjected to high tibial osteotomy and 50 patients were operated with partial fibulectomy. Functional outcome of both the procedure were compared with WOMAC score. Patients were followed up at 3 months 6 months and 9 months and reassessed. Result: There were a total of 100 patients with clinically and X-ray confirmed medial compartment osteoarthritis of knee (41 males and 59 females) with most patient in 51-60 year age group. mean pre operative WOMAC score was 82.38 and mean post operative score at 9 Month follow up was 38.43(p value <0.001) which is statistically significant. pre-operative VAS was 7.83 and post operative vas 2.78 and radiographic valgus angle preoperatively was 7.54 degrees of varus to postoperative valgus of 1.9 0 .
Conclusion:We want to conclude saying that partial fibulectomy is a safe, fast and affordable surgery to relieve pain and improve joint function and the medial joint space in human knee osteoarthritis. HTO is the surgery of choice in medial compartment OA associated with high degree of genu varum. From our study, it is quite clear that open wedge osteotomy using limb reconstruction system is an effective method of managing OA knee especially in younger patients with unicompartmental knee involvement. We strongly recommend this procedure in relatively younger patients as it may delay the need of joint replacement and in some cases, it may actually avoid it.
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