BRIEF BILATERAL CENTRAL FOLLOWING bilateral hip injury and cerebrovascular has not, as far as we know, is a rare primary cause central fracture DISLOCATION OF A CEREBROVASCULAR H. T. PHEN, Simultaneous 703 REPORTS N. V. GIRISH dislocation THE HIP ACCIDENT KUMAR, JOHN IRELAND of the accident as been previously a reported. In our case the diagnosis was delayed by one month due to lack ofobvious clinical signs. Case report. A 69-year-old man, previously healthy and mobile, was brought to hospital having been found in a chair, confused, incontinent and bleeding from the mouth. the was picture An aortic valve only significant was neurological subsequently The of confusion replacement medical and four history. aphasia signs. A cerebra! infarct was confirmed by a CT scan. patient regained consciousness admission and attempts at mobilisation later. He complained from the beginning years The earlier clinical without focal diagnosed and the after day began one week of hip and knee pain but no signs of injury were observed. Orthopaedic advice was sought one month after admission. Examination revealed restriction of a!! hip movements and radiography tion of both and later with (Fig. hips. 1), showed a central fracture A conservative regime was mobilisation with a frame he was able to move about a frame and with minimal continued. the house discomfort. dislocaaccepted Six months independently Discussion. Sixteen cases of bilateral central fracture dislocation of the hips associated with convulsions have been reported in the literature: in 14 the convulsions were iatrogenical!y induced ; we have found no reports of such dislocations due to convulsion from a cerebrovascular accident. The mechanism ofthese injuries has been discussed by Pearson and Hargadon (1962) and by Remec and Evarts (1983). In their view violent contraction of pelvic/trochanteric muscles occurs during convulsions and causes has varied the central dislocation. The treatment from reduction by traction through adopted the greater Fig. trochanter (Ligas 1939) to Schanz-Milch-Charry osteo- tomy (Francillon has been advised 1968). (Varma, Skeletal traction Seth and Verma in abduction 1981). In our case Correspondence © 1989 should cause British VOL. 71-B. Editorial Society of Bone $2.00 [Br] I 989 :7 1-B :703. No. 4. AUGUST 1989 and Joint Surgery diagnosis clinical was signs. delayed The by the possibility absence of hip of any dislocation be considered following convulsions if the patient complains of hip or knee from pain. any The authors would like to express their appreciation to Mrs Jill Jones, Medical Photographer, and Mrs Marion Kemp for her secretarial help. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. REFERENCES Francillon MR, Bilaterale zentrale chock. Praxis 1968,57:178-9. A. Lussazione centrale muscolare. Chir OrganiMot Pearson the Remec to Mr J. Ireland. 0301-620X/89/4R28 J Bone Joint Surg Officer the obvious Ligas H. T. Phen, MS. MCh Orth Orthopaedic Registrar N. V. Girish Kumar, DOrth. Orthopaedic Senior House J. Ireland, FRCS, Consultant Orthopaedic Surgeon King George Hospital, Ilford, Essex, IG2 7RL, England. I Varma JR, Hargadon acetabulum. PT, report. AN, Seth of Trauma bilaterale del femore durch da Electroscontrazione 1939-1940.25:171-81. U. Fractures of the pelvis involving the floor J Bone Joint Surg [Br] 1962 :44-B :50-61. Evarts CM. C/in Orthop dislocation Huftgelenksluxation SK, the Bilateral central dislocation 1983 : I 8 1 : I I 8-20. Verma hip: an 1981 :21 :499-500. M. Simultaneous unusual complication of the hip : a case bilateral of of eclampsia. central J