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Falgons CG, Park CC, Routt MLC, DeAngelis RD, Warner SJ. Traumatic hip dislocations associated with acute aortic injuries: A relevant injury complex. Injury 2025; 56:112172. [PMID: 39908770 DOI: 10.1016/j.injury.2025.112172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 01/14/2025] [Indexed: 02/07/2025]
Abstract
OBJECTIVES The primary aim of this study was to determine if an association exists between traumatic posterior hip dislocations and aortic injuries. Secondarily, this study assessed the incidence of chest imaging in patients with hip dislocations. METHODS Design: Retrospective Review of a Consecutive Case Series. SETTING Academic level I trauma centre. Patient Selection Criteria: Fifteen-thousand-four-hundred-thirteen consecutive traumatically injured patients with at least one orthopaedic injury were initially identified. After excluding patients without a posterior hip dislocation after blunt trauma, seven-hundred-nine patients were included. Outcome Measurements and Comparisons: The primary outcome was the coincidence of blunt traumatic aortic injury with acute posterior dislocation of a native hip. The secondary outcome was the rates of chest imaging to screen for blunt aortic injuries in patients with posterior hip dislocations. RESULTS The incidence of aortic injury with blunt trauma was 5.1 % in patients with a posterior hip dislocation and 1.6 % in patients without a posterior hip dislocation (OR = 3.3, CI: [2.3: 4.7], p < 0.001). Of the seven-hundred-nine patients with posterior hip dislocation, six hundred fifty-nine (93 %) received chest imaging as part of their initial workup, while thirty-four (4.8 %) never received chest imaging during hospitalization. CONCLUSIONS Despite improvements in automobile safety, this injury complex remains highly relevant. The findings advocate for routine chest imaging as part of the diagnostic trauma workup for patients with a native posterior hip dislocation.
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Affiliation(s)
- Christian G Falgons
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX.
| | - Connor C Park
- Creighton University School of Medicine-Phoenix, Phoenix, AZ
| | - Milton Lee Chip Routt
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Ryan D DeAngelis
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Stephen J Warner
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
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Yao Y, Ye H, Fang W, Feng R, Zhang C, Zheng L, Lv H, Li J, Jing J. Dislocation Does Not Seem To Be an Absolute Factor Effecting the Short- to Medium-Term Poor Prognosis of Patients with Acetabular Posterior Wall Fracture. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2025; 163:63-70. [PMID: 38423035 DOI: 10.1055/a-2265-0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Dislocation is a complication of acetabular fractures involving the posterior wall, but whether dislocation is an absolute factor impacting the short- to medium-term prognosis of the hip joint remains controversial. This study aimed to compare the short- to medium-term clinical and radiological results among patients diagnosed with an acetabular fracture involving the posterior wall, with or without dislocation.Seventy-nine patients diagnosed with an acetabular fracture involving the posterior wall were retrospectively divided into posterior dislocation and non-dislocation groups. All fractures were open reduction + internal fixation with a plate screw combination through the single Kocher-Langenbeck approach. The short- to medium-term radiographic outcomes of follow-up were evaluated using the Matta radiologic grading system, while the clinical outcomes were evaluated using the modified Merle d'Aubigné-Postel evaluation system.The mean follow-up duration for all patients was 43.90 (range 24-75) months. Both groups achieved similar short- to medium-term clinical and radiographic results. There seems to be no significant differences between the two groups regarding the short- to medium-term assessment of clinical and radiographic results and the occurrence of postoperative complications (p > 0.05).In patients with acetabular fractures involving the posterior wall, hip dislocation is probably not an absolute determinant of a poor outcome. Even with early reduction, the short- to medium-term prognosis results appear similar to those of patients without dislocation.
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Affiliation(s)
- Yunfeng Yao
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Houlong Ye
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wang Fang
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ru Feng
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chun Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liujie Zheng
- Department of Orthopaedic Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Lv
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jun Li
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Juehua Jing
- Department of Orthopaedics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Firoozabadi R, Collins AP. Novel Hip Containment Technique in Setting of Unstable Hip Joint in a Trauma Setting: A Case Report. JBJS Case Connect 2025; 15:01709767-202503000-00041. [PMID: 39946513 DOI: 10.2106/jbjs.cc.24.00436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2025]
Abstract
CASE A 39-year-old woman who was involved in a motor vehicle collision sustained a right hip posterior wall acetabular fracture-dislocation. Subsequent dislocation was noted at the 4-week point with gross instability and heterotopic ossification. She underwent a hip containment technique using a transfemoral neck tunnel through the quadrilateral surface and FiberTape. At 1-year postoperatively, she reported improvement in mobility without evidence of repeat dislocation. CONCLUSION This technique can be used for unstable hip sockets with a small posterior wall acetabular fracture to maintain hip stability. This is the first reported technique using an open intrapelvic approach to stabilize the hip.
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Affiliation(s)
- Reza Firoozabadi
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, Washington
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Jaecker V, Zocholl M, Friederichs J, Osten P, Fuchs T, Stuby FM, Regenbogen S. Intermediate to Long-Term Results Following Traumatic Hip Dislocation: Characteristics, CT-Based Analysis, and Patient-Reported Outcome Measures. J Bone Joint Surg Am 2024; 106:346-352. [PMID: 38113303 DOI: 10.2106/jbjs.23.00660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Traumatic hip dislocation is a rare yet severe injury. As the long-term morbidity, subsequent complications, and clinical outcomes are nearly unknown, we aimed to analyze traumatic hip dislocations and identify specific factors that may predict the clinical outcome. METHODS Data on injury-related characteristics and computed tomographic (CT) scans for all consecutive adult patients who had been managed for traumatic hip dislocation between 2009 and 2021 were analyzed. At the time of follow-up, the patients were assessed with regard to osteonecrosis, posttraumatic osteoarthritis (OA), further operations and complications, return to sports and work, and patient-reported outcome measures (PROMs), including the Tegner Activity Scale and modified Harris hip score. RESULTS One hundred and twelve patients (mean age [and standard deviation], 43.12 ± 16.6 years) were included. Associated acetabular rim and femoral head fractures (Pipkin Type I to IV) were observed in 44% and 40% of patients, respectively. Concomitant injuries occurred in 67% of the patients, most commonly involving the knee (29% of patients). Sixty-nine patients (61.6%) were available for follow-up; the mean duration of follow-up was 6.02 ± 3.76 years. The rates of osteonecrosis and posttraumatic OA were 13% and 31.9%, respectively, and were independent of the timing of hip reduction, leading to subsequent total hip arthroplasty (THA) in 19% of patients. Sciatic nerve injury occurred in 27.5% of the patients who were available for follow-up. Both THA and sciatic nerve injury were associated with posterior acetabular rim or Pipkin Type-IV fractures (p < 0.001). Only 33.3% of the patients returned to their pre-injury level of sports, 24.6% did not return to work, and 27.5% reported having sexual dysfunction. PROMs (Tegner Activity Scale, modified Harris hip score) were significantly worse in patients with osteonecrosis, posttraumatic OA, or residual sciatic nerve injury (p < 0.05). CONCLUSIONS Traumatic hip dislocations are predominantly associated with Pipkin and acetabular rim fractures, leading to overall limitations of activities of daily living, sports, and sexual function at intermediate to long-term follow-up. Patients with associated acetabular rim or Pipkin Type-IV fractures are most likely to require THA for the treatment of osteonecrosis or posttraumatic OA and are at greater risk for sustaining sciatic nerve injury. LEVEL OF EVIDENCE Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Vera Jaecker
- Center for Musculoskeletal Surgery, Charitè-University Medicine Berlin, Berlin, Germany
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | - Malin Zocholl
- Center for Musculoskeletal Surgery, Vivantes Klinikum, Berlin-Friedrichshain, Germany
| | - Jan Friederichs
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Philipp Osten
- Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | - Thomas Fuchs
- Center for Musculoskeletal Surgery, Vivantes Klinikum, Berlin-Friedrichshain, Germany
| | - Fabian M Stuby
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Stephan Regenbogen
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
- Department of Traumatology, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
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McGregor PC, Meldau JE, Liskutin T, Kelly RF, Levack AE, Cohen J, Summers H. Hospital transfer and delayed reduction of traumatic hip dislocations. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04768-3. [PMID: 36746785 DOI: 10.1007/s00402-023-04768-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 01/03/2023] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Native hip dislocations are high energy injuries that cause substantial patient morbidity. Expedient reduction has been demonstrated to improve patient outcomes. The objective of our study was to compare complication rates in patients with native hip dislocations who presented directly to a level-one trauma center with those transferred from an outside hospital (OSH). Our hypothesis was that those transferred from an OSH would experience a delay in reduction and subsequently would experience higher rates of avascular necrosis (AVN), post-traumatic arthritis (PTA), and need for secondary surgery. MATERIAL AND METHODS We conducted a retrospective chart review of all native hip dislocations from our level-one trauma center between January 2007 and December 2020. The initial query resulted 628 patients which was refined to 90 patients after excluding patients for incorrect diagnosis code or less than 6 months of follow-up. Our primary outcome was the development of AVN, PTA, and need for secondary surgery. Time from injury to reduction was recorded for all patients included. RESULTS For every one hour of delay in time to reduction, there was a 3.4% increase in the risk of developing AVN (p = 0.004) and a 4.3% increase in risk for developing PTA (p = 0.01). The risk of requiring a secondary surgery increased 4.6% for each hour of delay in reduction (p = 0.03). The average time to reduction of transferred patients was higher compared to those who presented directly to our center (13.8 h vs 5.7 h); however, transfer status was not found to be an independent risk factor for the measured outcomes. CONCLUSIONS Transfer status is not an independent risk factor for the development of AVN, PTA, or the need for a secondary surgery. However, transferred patients did experience an average delay of 8 h in time to reduction compared to those who presented directly to a trauma center. Of the 27 patients with a reduction delay greater than 12 h, 26 (96%) were transferred.
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Affiliation(s)
- Patrick C McGregor
- Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA
| | - Jason E Meldau
- Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA.
| | - Tomas Liskutin
- Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA
| | - Robert F Kelly
- Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA
| | - Ashley E Levack
- Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA
| | - Joseph Cohen
- Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA
| | - Hobie Summers
- Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA
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Rhoul A, Gartit M, Noumairi M, Elmir S, Allam AES, Lachkar A, Abdeljaouad N, Yacoubi H, EL Oumri AA. Screw Impingement Causing Massive Swelling of the Sciatic Nerve: A Case Report. Cureus 2022; 14:e31059. [DOI: 10.7759/cureus.31059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
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Wang S, Li B, Zhang Z, Yu X, Li Q, Liu L. Early versus delayed hip reduction in the surgical treatment of femoral head fracture combined with posterior hip dislocation: a comparative study. BMC Musculoskelet Disord 2021; 22:1057. [PMID: 34930251 PMCID: PMC8690980 DOI: 10.1186/s12891-021-04968-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Few studies focus on the treatment of femoral head fracture combined with posterior hip dislocation, and the safe interval time between injury and hip reduction remains controversial. The purpose of this study was to evaluate and compare the outcome of early and delayed hip reduction in the surgical treatment of femoral head fracture combined with posterior hip dislocation. Methods A total of 71 patients were evaluated in this retrospective study. Based on the time to hip reduction, they were divided into early group (within 6 h after injury) and delayed group (between 6 and 12 h after injury). The two groups were compared in reference to hospital day, fracture healing time, the occurrence of complications and final functional outcome. The Thompson-Epstein criteria, modified Merle D’Aubigné and Postel scores, visual analog scale (VAS) and Medical Outcomes Short Form 12-item questionnaire score (SF-12) were used for final functional evaluation. Results The mean hospital stay and fracture healing time in the early group were significantly lower than those in the delayed group. The incidence of infection, post-traumatic osteoarthritis, and avascular necrosis of the femoral head (ANFH) in the delayed group were higher than that in the early group. The early group had better functional outcomes in terms of Thompson-Epstein criteria, modified Merle D’Aubigné and Postel scores and physical component scale (PCS) than the delayed group. Conclusions For the treatment of femoral head fracture combined with posterior hip dislocation, the early and prompt hip reduction can effectively facilitate the fracture healing and patient rehabilitation, and obtain a better functional outcome.
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Affiliation(s)
- Shanxi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China.,Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Bohua Li
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhengdong Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiaojun Yu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, 430030, People's Republic of China
| | - Qin Li
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lei Liu
- Department of Orthopedics, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
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Chouhan D, Behera P, Ansari MT, Digge VK. Posterior hip dislocation associated with concomitant ipsilateral femoral head and shaft fractures: an unusual combination of injuries. BMJ Case Rep 2021; 14:e244453. [PMID: 34446518 PMCID: PMC8395262 DOI: 10.1136/bcr-2021-244453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/04/2022] Open
Abstract
The combination of posterior hip dislocation with an ipsilateral femoral head and shaft fractures is unusual. While cases of concomitant fractures of femoral head and shaft have been previously reported, the treatment of such injuries is challenging. Presence of an associated hip dislocation further complicates the matter. A timely diagnosis and treatment are crucial to have a good outcome.We are presenting the case of a 20-year-old man who sustained a traumatic posterior hip dislocation with ipsilateral femoral shaft and femur head fractures. After reducing the hip, we fixed the femoral shaft with a retrograde femur nail and the femoral head by the trochanteric flip approach in the same sitting. The patient returned to his pre-injury occupation after 4 months. He has been doing well until his last follow-up, 1 year after the surgery, thus emphasising the utility of following basic principles of trauma management in the management of unusual injuries.
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Affiliation(s)
- Deepak Chouhan
- Department of Orthopaedics, Kashmiri hospital and Heart care centre, Sunam, Punjab, India
| | - Prateek Behera
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Mohammed Tahir Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Kumar Digge
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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ÇALIŞKAN HM, JARADAT Ö, YETİŞ M, ÜNVEREN Z, ÇELİK B, SÖNMEZ SS. Asymmetrical Bilateral Traumatic Hip Dislocation with Segmental Femur Fracture. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2021. [DOI: 10.33706/jemcr.966370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Desai KB. Decoding the behaviour of extracapsular proximal femur fracture- dislocation - A systematic review of a rare fracture pattern. J Clin Orthop Trauma 2021; 18:157-170. [PMID: 34012770 PMCID: PMC8111678 DOI: 10.1016/j.jcot.2021.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/22/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Proximal femoral extracapsular fractures with associated ipsilateral hip dislocation is an extremely rare pattern of injury. These fractures may be associated with a spectrum of severity from isolated trochanteric fractures to comminuted intertrochanteric and subtrochanteric fractures with hip dislocation. To date, this pattern of injury is not described in any injury classification system and no clear cut guidelines for the same are available. The aim of this review is to provide an evidence based pooled analysis of the existing literature and develop guidelines that help surgeons tackle this rare injury pattern. METHODS A comprehensive review of the literature was undertaken using the PRISMA. Case reports and series of Extracapsular proximal femoral fracture dislocations published in PubMed, EMBASE, Springer, OvidSP, ScienceDirect, Web of Science and Google scholar between inception of journals to May 2020 were included in the review. A pooled analysis comparing the demography, pattern of the fracture, mode and mechanism of injury with the clinical and radiological outcome and complications was performed. RESULTS 52 cases from 46 case studies were included in the pooled analysis. There was a near significant association between avascular necrosis and mean time to reduction (p = 0.0865). Individuals with compound injury had 10.12 times higher risk of avascular necrosis (p = 0.009). No significant association between the pattern of proximal femur fracture and incidence of avascular necrosis (p = 0.116, chi-square). There was no significant association between polytrauma and poor clinical outcomes. (p = 0.231). CONCLUSIONS Principles of damage control orthopaedics should be followed in unstable patients with this rare fracture dislocation. Percutaneous Schanz screw reduction manoeuvre can be attempted gently with a low threshold to perform an open reduction. Every attempt at salvaging the fractured hip must be performed in young individuals with an arthroplasty standby for comminuted and unreconstructable cases.
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Affiliation(s)
- Keyur B. Desai
- Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India
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11
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Milenkovic S, Mitkovic M. Comment on: "Outcomes of surgical management regarding acetabular fractures: cases from African countries". INTERNATIONAL ORTHOPAEDICS 2021; 45:2751-2752. [PMID: 33890133 DOI: 10.1007/s00264-021-05049-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sasa Milenkovic
- University of Nis, Faculty of Medicine, Clinic for Orthopaedic Surgery and Traumatology, University Clinical Centre Nis, Bul. dr Zorana Djindjica 48, 18000, Nis, Serbia.
| | - Milan Mitkovic
- University of Nis, Faculty of Medicine, Clinic for Orthopaedic Surgery and Traumatology, University Clinical Centre Nis, Bul. dr Zorana Djindjica 48, 18000, Nis, Serbia
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12
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Mandel RT, Bruce G, Moss R, Carrington RWJ, Gilbert AW. Hip precautions after primary total hip arthroplasty: a qualitative exploration of clinical reasoning. Disabil Rehabil 2020; 44:2842-2848. [PMID: 33222555 DOI: 10.1080/09638288.2020.1845825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Hip precautions are movement restrictions that are often advised following primary total hip arthroplasty (PTHA) for osteoarthritis (OA), but there is limited evidence supporting their effectiveness in preventing dislocation. This study aimed to explore the clinical reasoning behind the continuation and discontinuation of hip precautions following PTHA for OA. MATERIALS AND METHODS Semi-structured interviews were conducted with therapists and surgeons at six centres using precautions and six centres not using precautions across secondary or tertiary NHS sites in England. Interviews were transcribed verbatim and thematically analysed. RESULTS Interviews were conducted with fourteen surgeons and eighteen therapists. Of these clinicians, eight surgeons and ten therapists routinely advised precautions. Clinicians continued to use precautions to avoid dislocation by creating a boundary to movement, particularly important when dealing with patients who "push" these boundaries. Clinicians discontinued precautions because of a perceived negative impact on patients and the lack of supporting evidence. In the absence of a rise in dislocation rates for these centres, others have now changed practice. CONCLUSION This study offers insight into the clinical reasoning behind the continuation and discontinuation of hip precautions following PTHA for OA. The use of precautions remains controversial and further work is required to determine whether or not they should be advised.IMPLICATIONS FOR REHABILITATIONRedesign of future rehabilitation pathways for primary total hip arthroplasty should take into account viewpoints from across the multidisciplinary team to aid decision making.Concern for patient behaviours, dislocation and litigation may be barriers to changing practice for rehabilitation after primary total hip arthroplasty.Clinicians may be discontinuing hip precautions because of known surgical advances, a perceived negative impact on patients and a lack of supporting evidence for historical practice.Individualised rehabilitation considerations are necessary for patients with risk factors that predispose them to dislocation after primary total hip arthroplasty, regardless of whether hip precautions are advised as standard at their given centre.
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Affiliation(s)
| | - Gemma Bruce
- Royal National Orthopaedic Hospital, Stanmore, UK
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Milenkovic S, Mitkovic M, Mitkovic M. Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture. Eur J Trauma Emerg Surg 2020; 48:613-619. [PMID: 32929549 DOI: 10.1007/s00068-020-01495-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Traumatic hip dislocation can be isolated or associated with acetabular fracture. Both injuries require emergency reduction of the dislocated hip. Avascular necrosis of the femoral head (AVN) is a potential complication that accompanies these severe injuries. Our objective is to identify the risk factors that cause AVN. METHODS We retrospectively analyzed 44 patients with traumatic hip dislocations (Group A) and patients with posterior fracture-dislocation of the acetabulum (Group B). The average follow-up was 5.38 years in Group A, 5.59 years in Group B. We used the Thompson-Epstein classification for hip dislocation and the Harris Hip Score (HHS) for evaluating final outcomes. RESULTS In Group A, we analyzed 21 patients with isolated posterior hip dislocation. We had one (4.76%) case of AVN. In Group B, we analyzed 23 patients with posterior acetabular fracture-dislocation. We had eight (34.78%) patients with AVN (p = 0.016, p < 0.05). With hip reduced 6-12 h after injury, we had AVN in one (4.34%) patient, with reduction 12-24 h, AVN was present in two (8.69%), while in hip reduction done after 24 h of injury, AVN was present in five (21.73%) patients (p = 0.030, p < 0.05). CONCLUSION An essential prerequisite for the prevention of AVN of the femoral head after hip dislocation is emergency hip reduction. In acetabular fracture-dislocation, emergency hip reduction, anatomical reduction of the acetabular fracture and early stable osteosynthesis are also important. Main factor affecting the development of AVN is late reduction of the hip.
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Affiliation(s)
- Sasa Milenkovic
- Medical Faculty, University of Nis, Nis, Serbia. .,Clinic for orthopaedic surgery and traumatology, Clinical Centre of Nis, Bul. dr Zorana Djindjica 48, 18000, Nis, Serbia.
| | - Milan Mitkovic
- Medical Faculty, University of Nis, Nis, Serbia.,Clinic for orthopaedic surgery and traumatology, Clinical Centre of Nis, Bul. dr Zorana Djindjica 48, 18000, Nis, Serbia
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Shigemura T, Miura M, Murata Y, Yamamoto Y, Maruyama J, Wada Y. A new closed reduction technique using a traction table to treat a traumatic posterior dislocation of the hip joint. Orthop Traumatol Surg Res 2020; 106:881-884. [PMID: 32386842 DOI: 10.1016/j.otsr.2020.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 02/03/2023]
Abstract
Traumatic hip dislocations should be reduced gently and promptly to prevent complications such as osteonecrosis of the femoral head, heterotopic ossification, incomplete recovery of sciatic nerve injury, and fractures of the femoral neck. Many closed reduction manoeuvres have been reported; however, these manoeuvres require forceful and sustained traction, which places an enormous physical burden on surgeons. The aim of the present technical note is to describe a new reduction manoeuvre that uses a traction table to decrease the physical burden experienced by surgeons.
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Affiliation(s)
- Tomonori Shigemura
- Department of orthopaedic surgery, Teikyo university Chiba medical center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan.
| | - Masataka Miura
- Department of orthopaedic surgery, Teikyo university Chiba medical center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan
| | - Yasuaki Murata
- Department of orthopaedic surgery, Teikyo university Chiba medical center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan
| | - Yohei Yamamoto
- Department of orthopaedic surgery, Teikyo university Chiba medical center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan
| | - Juntaro Maruyama
- Department of orthopaedic surgery, Teikyo university Chiba medical center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan
| | - Yuichi Wada
- Department of orthopaedic surgery, Teikyo university Chiba medical center, 3426-3 Anesaki, 299-0111 Ichihara, Chiba, Japan
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15
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Abstract
Background Dislocation of the hip is a well-described event that occurs in conjunction with high-energy trauma or postoperatively after total hip replacement. Methods In this review, the types, causes, and treatment modalities of hip dislocation are discussed and illustrated, with particular emphasis on the assessment, treatment, and complications of dislocations following total hip replacement. Results Hip dislocations are commonly classified according to the direction of dislocation of the femoral head, either anterior or posterior, and are treated with specific techniques for reduction. Generally, closed reduction is the initial treatment method, usually occurring in the emergency room. Bigelow first described closed treatment of a dislocated hip in 1870, and since then many reduction techniques have been proposed. Each method has unique advantages and disadvantages. Anterior hip dislocation is commonly reduced by inline traction and external rotation, with an assistant pushing on the femoral head or pulling the femur laterally to assist reduction. Posterior hip dislocations are the most common type and are reduced by placing longitudinal traction with internal rotation on the hip. Conclusion Patients with hip dislocations must receive careful diagnostic workup, and the treating physician must be well versed in the different ways to treat the injury and possible complications. Timely evaluation and treatment, including recognizing the potential complications, are necessary to offer the best outcome for the patient.
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16
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Massoud EIE. Neglected traumatic hip dislocation: Influence of the increased intracapsular pressure. World J Orthop 2018; 9:35-40. [PMID: 29564212 PMCID: PMC5859198 DOI: 10.5312/wjo.v9.i3.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 01/12/2018] [Accepted: 02/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate that the increased intracapsular pressure, during the delay period, can interrupt the blood flow to the femoral head.
METHODS An observational retrospective study included a group of 17 patients with traumatic hip dislocation, their ages at time of injury averaged 26 (range from 3 to 70) years. Outcomes were assessed clinically and radiographically at a period averaged 11.5 (range from 4 to 20) years.
RESULTS Minor trauma caused dislocation in seven and severe trauma in ten patients. All dislocations were posterior, six isolated dislocation and 11 were associated with other injuries. The negligence period averaged 2.5 (ranged from 1 to 4) d. At the latest visit, the radiography revealed normal hip in 11 and avascular necrosis (AVN) in six patients. Clinically, eight patients were rated as excellent, three good, three fair and three poor.
CONCLUSION We believe the factors that contribute to increased intracapsular pressure also increase the influence of delayed reduction toward the development of AVN.
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Affiliation(s)
- Elsayed Ibraheem Elsayed Massoud
- Department of Orthopaedic, Sohag Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Sohag 0026280, Egypt
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17
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Babalola RO, Laiyemo EA, Audu SS, Alatishe KA, Ijezie CN. Traumatic Hip Dislocations in an Orthopedic Center in Lagos. Niger Med J 2018; 59:20-23. [PMID: 31263318 PMCID: PMC6573479 DOI: 10.4103/nmj.nmj_139_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Hip dislocations are one of the orthopedic emergencies. They may result from a high-energy transfer as in a road traffic crash. Prompt recognition and treatment can reduce the long-term morbidity associated with delayed reduction. The goal of this study was to evaluate the epidemiology and outcome of treatment. Patients and Methods: This was a retrospective study that involved cases of traumatic hip dislocations seen at the National Orthopedic Hospital, Lagos, Nigeria, between January 1, 2010 and June 30, 2014. Biodemographic characteristics, mechanism of injury, and type of dislocations were retrieved from case files. Thompson and Epstein type of the dislocated hips as well as the presence of pre- and post-reduction complications was noted. Results: Forty-five patients had hip dislocations in the study period. Only 27 had the relevant information to be included in the study. All cases were posterior hip dislocations. The median follow-up was 9 months (range 6–30 months). More dislocations occurred on the left [18 (67.0%)] than on the right [9 (33.0%)]. The median age of patients was 37 years (range 21–73 years). Twenty-six dislocations (96.3%) were due to road traffic crash and a case (3.7%) was due to an industrial accident. Grade IV Epstein was the most common injury recorded. Twenty-four (89.0%) cases were managed with closed reduction, whereas the remaining 3 (11.0%) cases had open reduction. The associated complications observed were sciatic nerve injury, avascular necrosis of the head of the femur, and protrusio acetabuli. Conclusion: Road traffic crash remains a leading cause of traumatic hip dislocation. Severity of injury and delay in reduction contributes to the complications of treatment.
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Affiliation(s)
| | | | - Siyaka Simpa Audu
- Department of Orthopaedics and Trauma, National Orthopaedic Hospital, Igbobi, Lagos, Nigeria
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18
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Ahmed G, Shiraz S, Riaz M, Ibrahim T. Late versus early reduction in traumatic hip dislocations: a meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:1109-1116. [PMID: 28578459 DOI: 10.1007/s00590-017-1988-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/30/2017] [Indexed: 12/26/2022]
Abstract
AIMS Traumatic hip dislocations are considered orthopaedic emergencies that are treated with urgent reduction to decrease the rate of osteonecrosis of the femoral head. The aim of our study was to systematically review the literature that compares late (>6 h from the time of injury) to early (<6 h from the time of injury) reduction in all traumatic hip dislocations. MATERIALS AND METHODS We searched five databases from 1951 to 2016 for studies that evaluated timing of reduction and osteonecrosis of the femoral head in all traumatic hip dislocations. We performed a meta-analysis using a random-effects model to pool odds ratios (ORs) for a comparison of osteonecrosis of the femoral head between patients undergoing late versus early hip reduction. We also investigated the osteonecrosis rate in low- and high-grade traumatic hip dislocations. Descriptive, quantitative and qualitative data were extracted. RESULTS Of the 13 articles identified, five studies (retrospective cohort studies) were eligible for the meta-analysis, encompassing a total of 236 traumatic hip dislocations. The pooled odds ratio for osteonecrosis of the femoral head between late and early reduction was in favour of early hip reduction and statistically significant (OR = 5.00, 95% CI: 1.30, 19.29). No significant difference in the rate of osteonecrosis of the femoral head was detected between low- and high-grade traumatic hip dislocations according to the time threshold (OR = 1.71, 95% CI: 0.22, 13.22). CONCLUSIONS The cumulative evidence at present does indicate an association between late hip reduction and higher rate of osteonecrosis of the femoral head in all traumatic hip dislocations. Hence, all traumatic hip dislocations should be reduced as soon as possible to decrease the rate of osteonecrosis of the femoral head. However, the evidence does not indicate an association between the grade of dislocation and rate of osteonecrosis of the femoral head. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ghalib Ahmed
- Section of Orthopedics, Department of Surgery, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Salman Shiraz
- Section of Orthopedics, Department of Surgery, Hamad General Hospital, PO Box 3050, Doha, Qatar
| | - Muhammad Riaz
- Section of Orthopedics, Department of Surgery, Hamad General Hospital, PO Box 3050, Doha, Qatar.,Population Health Research Institute, St George's, University of London, London, UK
| | - Talal Ibrahim
- Section of Orthopedics, Department of Surgery, Hamad General Hospital, PO Box 3050, Doha, Qatar.
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Huber FA, Hirtler L, Kainberger F. Muscle ruptures in posterior hip dislocation-a case report. BJR Case Rep 2017; 3:20170020. [PMID: 30363242 PMCID: PMC6159191 DOI: 10.1259/bjrcr.20170020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/03/2017] [Accepted: 03/13/2017] [Indexed: 11/23/2022] Open
Abstract
Posterior hip dislocations are the most common luxation types of the hip joint and a well-known and well-described condition. However, we report a case of posterior hip luxation with a series of posttraumatic muscular disorders that were difficult to identify and have not been described previously in scientific literature. We performed clinical and radiological follow-up of an individual for a period of over 19 months post trauma. Informed consent for the anonymized publication of this case was received from the patient. The presented patient is a 20-year-old female, athletic individual in generally good health condition. Our patient suffered from a posterior hip dislocation after a skiing accident on an iced slope. Posttraumatic follow-up was performed owing to persistent moderate hip pain. The patient underwent several experts’ consultations as well as two MRI examinations at 2 months and 19 months after the skiing trauma. Both of the MRIs showed several ruptured parts of the periarticular musculature. At the second MRI, additional compensatory hypertrophy of the piriformis muscle was detected. This report clearly illustrates the importance of profound anatomical knowledge of the surrounding structures of the hip joint, especially as the high psychological strain on the patient could have been reduced by a swifter and appropriate diagnosis.
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Affiliation(s)
- Florian Alexander Huber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.,Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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20
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Selimi V, Heang O, Kim Y, Woelber E, Gollogly J. Chronic hip dislocations: a rarity. How should we treat them? J Orthop 2016; 13:431-436. [PMID: 27698547 DOI: 10.1016/j.jor.2016.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/22/2016] [Accepted: 09/02/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chronically dislocated hips (>6 weeks) are usually the consequence of difficulties accessing appropriate healthcare in a timely fashion after dislocation; this explains why they are more common in developing countries. Due to a lack of research, there is currently no consensus on the best treatment available for patients presenting with this condition. Therefore, it is important to assess the treatments available so as to ensure that doctors adequately manage those presenting with this debilitating condition in the future. OBJECTIVE To identify the best treatment strategy for chronic hip dislocations based on the treatment outcomes achieved by a free surgical clinic in Phnom Penh, Cambodia. PATIENTS AND METHOD A retrospective analysis of the surgical centre's electronic records was conducted. Patients presenting with hips dislocated for >6 weeks were included whilst congenitally dislocated hips were excluded. Treatment outcomes, based on follow up notes, were then assessed. Data abstracted during chart review was analysed using descriptive and comparative statistics. RESULTS 72 patients presented to the clinic with chronic hip dislocations. 42 patients received recorded treatment and 32 were followed up. Among patients with follow-up, 63% experienced 'good' outcomes after treatment. Open reductions, the most common treatment, were successful 65% of the time. The use of preoperative traction increased the success of open reductions by 13%, however, this result was not statistically significant (p = 0.64). CONCLUSION Open reductions with pre-operative traction seem to be an acceptable treatment in this setting.
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Affiliation(s)
- V Selimi
- University of Cambridge, Cambridge, England, United Kingdom
| | - O Heang
- Children's Surgical Centre, Phnom Penh, Cambodia
| | - Y Kim
- Children's Surgical Centre, Phnom Penh, Cambodia
| | - E Woelber
- WWAMI (Washington, Alaska, Montana and Idaho), USA
| | - J Gollogly
- Children's Surgical Centre, Phnom Penh, Cambodia
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21
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Kubo Y, Yamamoto T, Motomura G, Kido S, Karasuyama K, Sonoda K, Iwamoto Y. Transient epiphyseal lesion of the femoral head after traumatic hip dislocation: A case report. Int J Surg Case Rep 2016; 24:46-9. [PMID: 27179337 PMCID: PMC4873613 DOI: 10.1016/j.ijscr.2016.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/02/2016] [Accepted: 05/03/2016] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION We experienced a rare case in which magnetic resonance imaging (MRI) showed a transient epiphyseal lesion of the femoral head four months after traumatic hip dislocation. To our knowledge, there have been no previously published reports on the development of such transient lesions after traumatic hip dislocation involving no abnormalities just after dislocation. PRESENTATION OF CASE We report a 22-year-old man who showed a transient epiphyseal lesion of the femoral head after traumatic hip dislocation. On MRI performed two days after dislocation, no bony injuries were observed around the hip joint. Four months after dislocation, the patient suddenly experienced right hip pain without any new trauma or injury. A low-intensity band convex to the articular surface was apparent above the epiphyseal scar on T1-weighted imaging, and bone marrow edema was observed around the band lesion on short-tau inversion recovery imaging. Following a two-month period of non-surgical conservative therapy, the patient's hip pain resolved and the low-intensity band was no longer observed on follow-up MRI. DISCUSSION Although the detailed pathogenesis of this transient changes was unclear, we speculate that prolonged rest after traumatic hip dislocation may contribute to bone insufficiency, resulting in an insufficiency fracture of the femoral head. CONCLUSION This study suggests that transient epiphyseal lesions of the femoral head may occur in patients with a history of traumatic hip dislocation associated with an adapted long-term rest.
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Affiliation(s)
- Yusuke Kubo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoshi Kido
- Department of Orthopaedic Surgery, Yamaguchi Red Cross Hospital, 53-1 Yahatababa, Yamaguchi 753-8519, Japan
| | - Kazuyuki Karasuyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1-3-1, Kuzuharatakamatsu, Kokuraminami-ku, Kitakyushu 800-0296, Japan
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22
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Outcome of transtrochanteric rotational osteotomy for posttraumatic osteonecrosis of the femoral head with a mean follow-up of 12.3 years. Arch Orthop Trauma Surg 2015; 135:1257-63. [PMID: 26173626 DOI: 10.1007/s00402-015-2282-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study examined the outcomes of applying transtrochanteric rotational osteotomy (TRO) for posttraumatic osteonecrosis of the femoral head (ON). PATIENTS AND METHODS We retrospectively reviewed 28 hips in 28 patients (male, n = 17; female n = 11) with a mean age of 34.8 years (12-61 years) at the time of TRO. Transtrochanteric anterior rotational osteotomy (ARO) was used when the lesion was localized on the anterior aspect of the femoral head, and transtrochanteric posterior rotational osteotomy (PRO) was indicated in patients with lesions limited to the posterior aspect of the femoral head. The mean follow-up period was 12.3 years (5.0-21.3 years). We investigated the patients' clinical and radiological factors, including age, sex, body mass index, preoperative Harris Hip Score (HHS), type of antecedent trauma, preoperative stage, and postoperative intact ratio (the ratio of the intact articular surface of the femoral head to the weight-bearing surface of the acetabulum). We divided the patients into a hip-survival group and a conversion-to-total hip arthroplasty (THA) group and then compared these factors between the two groups. RESULTS At the final follow-up, 22 hips had survived with a mean HHS of 85.8. The remaining six hips underwent THA at a mean of 10.2 years after TRO. The preoperative stage was correlated with hip survival. Furthermore, the postoperative intact ratio was significantly lower in the conversion-to-THA group. Based on the receiver operating characteristic curve, a ratio of less than 33.6 % was found to be associated with the need to convert to THA. CONCLUSIONS TRO to correct posttraumatic ON resulted in favorable midterm results. The possible risk factors for conversion to THA were an advanced preoperative stage and a postoperative intact ratio of less than 33.6 %.
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Abstract
Osteonecrosis, also known as avascular necrosis or AVN, is characterized by a stereotypical pattern of cell death and a complex repair process of bone resorption and formation. It is not the necrosis itself but rather the resorptive component of the repair process that results in loss of structural integrity and subchondral fracture. Most likely, a common pathophysiological pathway exists involving compromised subchondral microcirculation. Decreased femoral head blood flow can occur through three mechanisms: vascular interruption by fractures or dislocation, intravascular occlusion from thrombi or embolic fat, or intraosseous extravascular compression from lipocyte hypertrophy or Gaucher cells. In this review, we emphasize etiologic relationships derived mostly from longitudinal cohort studies or meta-analyses whose causal relationships to osteonecrosis can be estimated with confidence. Understanding risk factors and pathophysiology has therapeutic implications since several treatment regimens are available to optimize femoral head circulation, interrupt bone resorption, and preserve the subchondral bone.
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24
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Stein MJ, Kang C, Ball V. Emergency department evaluation and treatment of acute hip and thigh pain. Emerg Med Clin North Am 2015; 33:327-43. [PMID: 25892725 DOI: 10.1016/j.emc.2014.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although the incidence of hip fractures is decreasing, the overall prevalence continues to increase because of an aging population. People older than 65 suffer fractures at a rate of 0.6% per year--2% per year for persons older than 85. One in 5 patients suffering a hip fracture will die within a year. Additionally, the emergency physician must consider entities such as avascular necrosis, compartment syndrome, and muscular disruption. This article reviews patterns and complications of acute hip and thigh injuries and clinically relevant diagnostic, anesthetic, and treatment options that facilitate timely, appropriate, and effective emergency department management.
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Affiliation(s)
- Matthew Jamieson Stein
- Department of Emergency Medicine, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 94804, USA.
| | - Christopher Kang
- Department of Emergency Medicine, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 94804, USA
| | - Vincent Ball
- Department of Emergency Medicine, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 94804, USA.
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25
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Rahimi Shorin H, Azizbeig Mohajer M, Parsa A, Azhari A, Assadian M. Femoral Nerve Palsy Following Delayed Reduction of a Dislocated Hip in a 44- Year-old Man. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e12579. [PMID: 24719726 PMCID: PMC3965859 DOI: 10.5812/ircmj.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/02/2013] [Accepted: 08/21/2013] [Indexed: 11/30/2022]
Abstract
Introduction: Incidence of nerve injury in traumatic hip dislocations is up to 10 %. Sciatic nerve is the most common injured nerve in this setting. In the medical literature, there are few documented cases of femoral nerve injury following hip dislocations. Case Report: We report a 44-year-old man with right femoral nerve palsy following delayed reduction of an anterior dislocation of hip. Conclusion: Two months after closed reduction, complete clinical recovery of right femoral nerve was achieved and the patient was able to resume his job.
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Affiliation(s)
- Hassan Rahimi Shorin
- Department of Orthopaedic Surgery, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | | | - Ali Parsa
- Department of Orthopaedic Surgery, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding Author: Ali Parsa, Department of Medical Physics and Rehabilitation, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-9155056358, E-mail:
| | - Amin Azhari
- Department of Medical physics and Rehabilitation, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Maryam Assadian
- Department of Orthopaedic Surgery, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Zlotorowicz M, Czubak J, Caban A, Kozinski P, Boguslawska-Walecka R. The blood supply to the femoral head after posterior fracture/dislocation of the hip, assessed by CT angiography. Bone Joint J 2013; 95-B:1453-7. [PMID: 24151262 DOI: 10.1302/0301-620x.95b11.32383] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The femoral head receives blood supply mainly from the deep branch of the medial femoral circumflex artery (MFCA). In previous studies we have performed anatomical dissections of 16 specimens and subsequently visualised the arteries supplying the femoral head in 55 healthy individuals. In this further radiological study we compared the arterial supply of the femoral head in 35 patients (34 men and one woman, mean age 37.1 years (16 to 64)) with a fracture/dislocation of the hip with a historical control group of 55 hips. Using CT angiography, we identified the three main arteries supplying the femoral head: the deep branch and the postero-inferior nutrient artery both arising from the MFCA, and the piriformis branch of the inferior gluteal artery. It was possible to visualise changes in blood flow after fracture/dislocation. Our results suggest that blood flow is present after reduction of the dislocated hip. The deep branch of the MFCA was patent and contrast-enhanced in 32 patients, and the diameter of this branch was significantly larger in the fracture/dislocation group than in the control group (p = 0.022). In a subgroup of ten patients with avascular necrosis (AVN) of the femoral head, we found a contrast-enhanced deep branch of the MFCA in eight hips. Two patients with no blood flow in any of the three main arteries supplying the femoral head developed AVN.
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Affiliation(s)
- M Zlotorowicz
- The Medical Centre of Postgraduate Education, Gruca Teaching Hospital, Department of Orthopaedics, Pediatric Orthopaedics and Traumatology, Konarskiego 13, 05-400 Otwock, Poland
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27
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Chouhan DK, Dhillon M, Bachhal V, Prabhakar S. Atraumatic heterotopic ossification of iliopsoas muscle: a case report. Orthop Surg 2013; 4:197-201. [PMID: 22927156 DOI: 10.1111/j.1757-7861.2012.00183.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Devendra Kumar Chouhan
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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28
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Abstract
OBJECTIVES The objective was to report the ability of a magnetic resonance image to document the integrity of the obturator externus tendon after posterior hip dislocation as a potential predictor for preserved femoral head vascularity. DESIGN Retrospective radiographic and clinical pilot study. SETTING Level I trauma center. PATIENTS/PARTICIPANTS Nineteen consecutive patients with traumatic posterior hip dislocation. OUTCOME EVALUATION: Intraoperative correlation of soft tissue damage and radiographic assessment of avascular necrosis of the femoral head 3 years postinjury. METHODS Magnetic resonance imaging performed in the acute phase of posterior hip dislocation. Correlation with intraoperative findings during surgical hip dislocation and with avascular necrosis 3 years postinjury. RESULTS The obturator externus tendon was intact in all cases with preserved femoral head vascularity. After a 3-year follow up, there were no cases of avascular necrosis. CONCLUSION In this small series of patients, posterior hip dislocation did not imply a tear of the obturator externus muscle. An intact obturator externus tendon suggests preservation of the deep branch of the medial femoral circumflex artery to the femoral head.
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