Superior fracture-dislocation of the hip

Summary A case of superior fracture-dislocation of the hip following a low-energy injury is reported. The direction of the dislocation is uncommon. Radiological investigation was delayed for 5 months and then showed the appearances of a radiologically perfect false acetabulum. The fracture-dislocation was a type IV with an associated fracture of the femoral neck, an injury which is expected to produce a high rate of avascular necrosis of the femoral head. However, bone scans suggested that the femoral head was viable.

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Zusammenfassung Es wird der Fall eines Patienten berichtet, der nach einer Verletzung mit geringer Gewalteinwirkung eine Hüftgelenksfraktur mit Dislokation nach proximal aufwies. Die Richtung der Dislokation is ungewöhnlich. Eine radiologische Untersuchung fand erst nach 5 Monaten statt und bot das Erscheinungsbild eines vollständig falschen Acetabulums. Die Frakturdislokation war vom Typ IV mit einer zusätzlichen Fraktur des Femurhalses. Derartige Verletzungen sind in der Regel mit einer hohen Rate avaskulärer Nekrosen des Femurkopfes verbunden. Die Szintigraphie zeigte jedoch einen vitalen Femurkopf.

     

The Pipkin fracture-dislocation of the hip

The 'Pipkin' fracture-dislocation of the hip is an injury that is easily missed and is associated with serious sequelae. Eighty posterior dislocations of the hip were studied; there were nine 'Pipkin' injuries, seven of which are reported. The aetiology and management is discussed and the literature is reviewed. Guidelines for management are suggested.     

Dislocation and fracture-dislocation of the hip.

Of 54 patients with posterior dislocations of the hip of type I and type II (Stewart and Milford 1954), 47 were followed for a mean period of 6.7 years (2 to 11). Of these, 23 had dislocation with minimal lesions of the acetabulum (type I) and 24 had an avulsed dorsocranial fragment (type II). All were reduced by closed methods within six hours. The subsequent treatment of type I dislocations was conservative. At the beginning of the period type II injuries were treated conservatively, but surgery was increasingly chosen for later cases. Type I dislocations had significantly better results (p < 0.05) than type II fracture-dislocations, regardless of the method of treatment. There were no essential differences between the results of surgical and conservative treatment in type II dislocations.     

Total hip arthroplasty in chronic unreduced hip fracture-dislocation

We treated 15 patients with chronic unreduced hip fracture-dislocations at our hospital; all patients sustained the fracture-dislocations in motor vehicle accidents. All presented to our institution more than 6 months after initial treatment at their local hospitals with uncontained femoral heads; all underwent 1-stage total hip arthroplasty with bone grafting. These patients were monitored for a mean of 71.5 months (range, 36-96 months). All patients had significantly decreased pain, increased function, and increased range-of-motion scores using the Merle d'Aubigné scoring system. All grafts showed radiographic evidence of union. There were 2 dislocations, 1 transient peroneal nerve palsy, and 1 superficial infection. Total hip arthroplasty is effective for relieving pain and restoring function in chronic unreduced hip fracture-dislocations.     

The treatment of fracture-dislocation of the hip by total hip arthroplasty

Five patients with chronic and subacute unreduced fracture-dislocation of the hip were treated successfully by total hip arthroplasty. The regimen developed was as follows: The first stage, in general, consisted of removal of the head of the femur and reduction and internal fixation of the acetabular fragments. Surgery to the sciatic nerve, if necessary, was done at this time. This was followed by total hip arthroplasty in five to eight weeks as a second stage. If severe fracture of the acetabulum occurred with dislocation of the hip, and the hip could be reduced, total hip arthroplasty could be done in one stage, either soon after the injury or at a later time. Such a procedure restores almost normal function to a hip that otherwise may remain painful and stiff because of traumatic arthritis and disturbed anatomical relationships of the acetabulum to the femoral head, and may save the patient much time and suffering.     

Central fracture-dislocation of the hip in a child

A case report of a 10-year-old child with a central fracture-dislocation of the hip, managed by open reduction is presented, with a long-term result. The rarity of this injury in children is discussed, with the possible complications of inadequate joint congruity and potential growth injury.     

Arthroscopy for hip dislocation and fracture-dislocation

We reviewed consecutive patients undergoing hip arthroscopy for loose bodies after sustaining hip dislocations and fracture-dislocations not requiring open fracture management. Eleven patients were identified, all with intra-articular loose bodies diagnosed by computed tomography. After 3 weeks, all patients underwent hip arthroscopy in which loose bodies were removed and labral pathology debrided. No patient developed any of the complications (avascular necrosis, heterotopic ossification, nerve injury) associated with hip arthrotomy. Arthroscopic treatment of intraarticular loose bodies after hip dislocations and fracture-dislocations allows excellent joint visualization for loose body removal and labral tear diagnosis and treatment.     

Total hip arthroplasty and acetabular bone grafting for unreduced fracture-dislocation of the hip

Functional restoration after chronic persistent fracture-dislocation of the hip was achieved by total hip arthroplasty (THA) in two patients with history of severe multiple injuries. Acetabular deficiency was corrected by use of the femoral head as an autologous bone graft. A 24-year-old man and a 42-year-old woman were treated for persistent fracture-dislocation of the hip two years and one year, respectively, after the accidents. In both, total hip arthroplasty in combination with acetabular bone grafts, with the femoral head, produced satisfactory clinical results at follow-up periods of 59 and 55 months.     

Posterior fracture-dislocation of the hip: an epidemiologic review.

A retrospective study of 46 posterior fracture-dislocations of the hip showed that reduction of the dislocation within 24 hours was the most important initial treatment. Open reduction and fixation of the fracture could be delayed up to 4 weeks to allow associated injuries to be treated, and this technique was indicated to remove intra-articular bone fragments or for residual instability. Long-term disability resulted in every patient, regardless of the severity of the initial injury or the method of treatment. Half of the patients never returned to work. Of the 46 patients 43 were unrestrained occupants in vehicular accidents. Multiple injury occurred in 75% of the patients.     

陈旧性髋关节骨折脱位行全髋置换后早期脱位1例

1　病例资料患者 ,男 ,5 9岁 ,因“陈旧性左髋关节脱位 2年”于 1999年 8月 3日入院。患者 1996年车祸致左髋臼粉碎骨折并股骨头中心脱位 ,在外院行手术复位、螺钉内固定术。术后 3个月出现左髋部疼痛 ,跛行加重。Ｘ线片显示 :左髋关节后上脱位。 1997年再次手术复位 ,9个月后复查发现左髋关节再次脱位 ,因无疼痛 ,活动尚可 ,未再治疗。现因活动时出现疼痛 ,遂到我院治疗。查体 :左髋部外上隆起畸形 ,见陈旧性瘢痕 ,左下肢轻度内收 ,短缩 4ｃｍ ,髋关节屈曲受限 ,达90°。Ｘ线片示 :左髋臼陈旧性粉碎性骨折 ,左髋关节脱位 (图 1)。充分牵引…     

Central fracture-dislocation of the hip joint. Clinical analysis of 40 cases

From 1957 to 1986, 40 cases of central fracture-dislocation of hip joint, 36 fresh and 4 old, were treated. Classification concerning the lesional patterns, indications for operative and non-operative treatment together with the factors affecting prognosis were discussed. In conclusion firstly, treatment by means of traction, simple and easy to handle, is well suited to most cases, if reduction has been satisfactory and maintained well, permitting early motion, for sufficient period of time for healing. Secondly, operation is only fit for fracture-dislocation, of which reduction has not been good enough and that it would not subject the patient to much surgical risk. Lastly, poor reduction, traction time not long enough, accetabular roof fracture or femoral head fracture and extensive damage or concomitant fracture of the same limb are the recessive factors influencing outcome.     

Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study

OBJECTIVE: Traumatic dislocation and fracture-dislocation of the hip is an absolute orthopedic emergency that is steadily increasing in incidence. Early recognition and prompt, stable reduction is the essence of successful management. A delay in recognition and reduction leads to preventable complications and morbidity. The purpose of this retrospective study is to identify prognostic factors that predict long-term outcome after hip dislocation. METHODS: Between 1980 and 1994, 107 patients with traumatic dislocation of the hips were treated, and 62 are reviewed in this study. There were 57 posterior fracture-dislocations and 5 anterior-obturator dislocations. All of the patients' charts were reviewed. The physical examinations and radiologic controls of the patients who were called for last follow-up examination were performed by the first two authors (V.S. and E.K.). Anterior and posterior fracture-dislocations were classified according to the classification system developed by Steward and Milford and femoral head fractures were classified according to the Pipkin classification. All of the hips were classified as very good, good, medium, fair, and poor according to the functional evaluation system described by Merle d'Aubigne. Statistical analysis of the results was performed. RESULTS: There were 47 male patients and 15 female patients, with ages ranging from 14 to 72 years (mean, 34.5 years). Traffic accidents constituted the leading cause of traumatic dislocation in this series (52 cases [83.9%]). Associated injuries were found in 44 cases (71%). Fifty patients were treated with closed reduction, and 12 patients were treated with open reduction. Thirty-five hips (56.5%) were reduced within 12 hours. Full weight-bearing was resumed between 2 and 10 weeks (average, 8 weeks) after injury. In follow-up periods ranging from 3.6 years to 18.4 years (mean, 9.6 years), 44 patients (71%) had very good or good to medium results. Ten patients (16.1%) developed late posttraumatic osteoarthritis of the hip, and 5 patients (9.6%) developed osteonecrosis of the femoral head. In this study, it is found that the time between injury and reduction and the associated injuries are the most important factors in long-term prognosis. CONCLUSION: We believe that good results were obtained in patients with early, stable, and accurate reductions by either closed or open methods. Concentric reduction absolutely should be confirmed by radiographs of the pelvis and, if necessary, by computed tomographic scan. The routine use of seat belts could have prevented many of these injuries.     

Treatment of fracture-dislocation of the hip with complete destruction of the proximal end of femur by total hip arthroplasty

A case of fracture-dislocation of the hip with loss of bone from the proximal part of the femur due to a war injury is described.

It is concluded that a total hip arthroplasty after 3 months is a suitable treatment.