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Wong MYZ, Ghobrial M, Han WM, Alsousou J, Carrothers A, Hull P, Chou D, Rawal J. The floating hip injury: a descriptive study and case-control analysis. Hip Int 2024; 34:122-133. [PMID: 36912024 PMCID: PMC10787386 DOI: 10.1177/11207000231160075] [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] [Indexed: 03/14/2023]
Abstract
PURPOSE A "floating hip" (FH) injury is a rare injury describing the simultaneous ipsilateral fracture of the femur and pelvis or acetabulum (P/A). We describe our experience with patients presenting with FH injuries and compare them to controls with similar P/A fractures but without femoral involvement. METHODS Medical records and radiographs of FH patients and controls presenting to our tertiary centre between 2015 and 2020 were reviewed. Follow-up data from outpatient clinical records were also extracted. The control group were extensively matched by age, sex, body mass index, fracture classification and energy of injury. RESULTS From 1392 recorded P/A fractures, 42 FH cases were identified (average age 39 years, 78.6% males). The most common femoral fracture was the midshaft (35.7%), followed by the neck of femur (26.2%). 90.5% of FH injuries were due to high-energy mechanisms. 64.3% of P/A fractures, and 100% of femoral fractures were managed surgically. Compared to controls, FH cases were more likely to have additional orthopaedic injuries (73.8% vs. 40.5%, p = 0.002), more total theatre admissions (mean 2.5 vs. 1.19, p < 0.001), longer hospital stays (28.3 vs. 14.9 days, p = 0.02), and a higher rates of post-op complications (53.8% vs. 20%, p = 0.025). CONCLUSIONS We report differences in the presentation, management, and outcomes of FH injuries versus controls, even after extensive matching for confounders. These differences may inform future treatment strategies for the FH injury.
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Affiliation(s)
- Mark Y Z Wong
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Marios Ghobrial
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Win M Han
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joseph Alsousou
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrew Carrothers
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter Hull
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daud Chou
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jaikirty Rawal
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Zarei R, Tavassoli M, Baroutkoub M, Afzal S. Concurrent ipsilateral fractures of acetabular posterior wall and femoral shaft associated with posterior hip dislocation: A case report and literature review of a rare injury. Int J Surg Case Rep 2023; 113:109035. [PMID: 37976719 PMCID: PMC10685006 DOI: 10.1016/j.ijscr.2023.109035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION A floating hip injury involving the acetabulum and femur, often complicated by hip dislocation, necessitates a timely and appropriate management strategy to preserve the extremity and patient well-being. CASE PRESENTATION We present a case of a 20-year-old male with concurrent fractures of the acetabular posterior wall, a comminuted femoral shaft, and posterior hip dislocation. Reduction of the dislocated hip posed a challenge due to the femoral shaft fracture. We successfully employed an innovative technique, using pins proximal and distal to the shaft fracture in conjunction with a temporary external fixator, later replaced by an interlocking nail after hip reduction. Subsequently, we addressed the acetabular fracture through a posterior hip approach, enabling the patient to regain full weight-bearing capacity within a few months. DISCUSSION In managing concurrent injuries in a floating hip, particularly when a femoral shaft fracture is involved, innovative approaches, such as the one described in this study, are crucial for timely hip reduction. Following hip reduction, a series of surgeries are required to address the multiple lower extremity injuries, prioritizing those with the highest risk of adverse events and neurovascular complications. CONCLUSION Urgent procedures for multiple fractures in orthopedic trauma surgery are pivotal for the best long-term outcomes. Prioritizing these urgent procedures, even through unconventional transient methods when conventional means are unavailable, can prevent long-term complications such as avascular necrosis. Effective and timely management is paramount for optimal patient recovery.
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Affiliation(s)
- Reza Zarei
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavassoli
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Baroutkoub
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Afzal
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Giordano V, Miura KF, Calegari IT, Pires RE, Freitas A, Altamirano-Cruz MA, Taype D, Giannoudis PV. Simultaneous ipsilateral floating hip and knee: the double floating extremity-a systematic review and proposal of a treatment algorithm. Eur J Trauma Emerg Surg 2023; 49:2057-2069. [PMID: 37160440 DOI: 10.1007/s00068-023-02277-x] [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] [Received: 10/10/2022] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To systematically review the currently available existing evidence related to the presentation and management of simultaneous floating hip and knee injuries to identify injury characteristics, treatment strategies, and complications. METHODS Data sources: Relevant articles were identified by searching Medline, PubMed, and Google Scholar databases with no language restrictions. Manual searches of other relevant databases (SciELO and grey literature databases) and reference lists of primary articles found from initial searches were also conducted. STUDY SELECTION All types of study designs published from January 1st, 2000 to October 1st, 2022 involving skeletally mature patients with simultaneous floating hip and knee injuries were included. DATA EXTRACTION Basic information and specific injury-related information were collected. RESULTS Eight case reports were included. No study adequately reported the case with sufficient detail to allow other investigators to make inferences, nor was the result properly calculated, nor was the follow-up considered adequate for adequate functional assessment to occur in 80% of the studies. CONCLUSION The exact treatment strategy and the follow-up time are not uniform across the included studies; therefore, they are not sufficient to adequately recommend surgical approach, timing of fixation, and fixation method. Our findings warrant the need for better documentation and reporting information about the mode of treatment of simultaneous floating hip and knee injuries.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° Andar, Gávea, Rio de Janeiro, RJ, 22430-160, Brazil.
- Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, Brazil.
| | - Kenji Fonseca Miura
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° Andar, Gávea, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Igor Tirelo Calegari
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2° Andar, Gávea, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Robinson Esteves Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | | | - Danilo Taype
- Sección de Trauma, Instituto de Ortopedia y Traumatología Carlos E. Ottolenghi, Hospital Italiano de San Justo Agustin Rocca, Buenos Aires, Argentina
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK
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Yang Y, Zou C, Fang Y, Shakya S. Medium-term clinical results in patients with floating hip injuries. BMC Surg 2023; 23:40. [PMID: 36803387 PMCID: PMC9940332 DOI: 10.1186/s12893-023-01927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND The objective of this study was to evaluate the effectiveness of our strategy for managing floating hip injuries. METHODS From January 2014 and December 2019, all patients with a floating hip underwent surgical treatment in our hospital were included in the retrospective study, with a minimum follow-up of 1 year. All patients were managed according to a standardised strategy. Data on epidemiology, radiography, clinical outcomes and complications were collected and analysed. RESULTS Twenty-eight patients were enrolled, with an average age of 45 years. The mean follow-up was 36.9 months. According to the Liebergall classification, Type A floating hip injuries predominated (n = 15, 53.6%). Head and chest injuries were the most common associated injuries. When multiple operative settings were required, we prioritized the fixation of the femur fracture at the first operation. The mean time from injury to definitive femoral surgery was 6.1 days, with most (75%) femoral fractures treated with intramedullary fixation. More than half (54%) of acetabular fractures were treated with a single surgical approach. Pelvic ring fixation included isolated anterior fixation, isolated posterior fixation, combined anterior and posterior fixation, of which isolated anterior fixation was the most common. Postoperative radiographs suggested that the anatomic reduction rates of acetabulum and pelvic ring fractures were 54% and 70%, respectively. According to grading system of Merle d'Aubigne and Postel, 62% of patients achieved satisfactory hip function. Complications included delayed incision healing (7.1%), deep vein thrombosis (10.7%), heterotopic ossification (10.7%), femoral head avascular necrosis (7.1%), post-traumatic osteoarthritis (14.3%), fracture malunion (n = 2, 7.1%) and nonunion (n = 2, 7.1%). In the patients with complications described above, only two patients underwent resurgery. CONCLUSIONS Although there is no difference in clinical outcomes and complications among different types of floating hip injuries, special attention should be paid to anatomical reduction of the acetabular surface and restoration of the pelvic ring. In addition, the severity of such compound injuries often exceeds that of an isolated injury and often requires specialised multidisciplinary management. Because of no standard guidelines for treatment of such injuries, our experience in the management of such a complex case is to fully assess the complexity of the injury and formulate an appropriate surgical plan based on the principles of damage control orthopaedics.
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Affiliation(s)
- Yun Yang
- grid.412901.f0000 0004 1770 1022Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan People’s Republic of China
| | - Chang Zou
- grid.412901.f0000 0004 1770 1022Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan People’s Republic of China
| | - Yue Fang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Sujan Shakya
- grid.412901.f0000 0004 1770 1022Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan People’s Republic of China
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Audretsch CK, Trulson A, Stöckle U, Histing T, Küper MA, Herath SC. „Floating Hip“: Epidemiologie und Qualität der Versorgung. ZEITSCHRIFT FÜR ORTHOPÄDIE UND UNFALLCHIRURGIE 2022; 161:160-167. [PMID: 36195111 DOI: 10.1055/a-1918-2243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Zusammenfassung
Einleitung Bei einer „floating-hip“-Verletzung handelt es sich um eine seltene, in der Behandlung komplexe Fraktur, die das Becken und das ipsilaterale Femur betrifft. Daten und
Studien zu diesem Thema sind immer noch spärlich. Die optimale Strategie für die chirurgische Behandlung und damit die daraus resultierende Behandlungsqualität ist nach wie vor umstritten;
häufig wird eine „Femur-first“-Strategie bevorzugt. Methoden Retrospektiv wurden Patienten mit einer Beckenfraktur untersucht, die zwischen 2003 und 2017 im Level-I-Traumazentrum der
Universität Tübingen behandelt wurden. Patienten mit einer zusätzlichen ipsilateralen Femurfraktur wurden in diesem Kollektiv identifiziert. Wir verglichen die Qualität der Behandlung von
Beckenfrakturen zwischen „floating-hip“- und „non-floating-hip“-Beckenfrakturen. Ergebnisse Proximale Femurfrakturen traten bei Beckenringfrakturen häufiger auf (n = 16) als bei
Azetabulumfrakturen (n = 1). „Floating-hip“-Verletzungen treten bei jüngeren polytraumatisierten männlichen Patienten häufiger auf. Beckenfrakturen bei „floating-hip“-Verletzungen werden
häufiger operiert (62,8% vs. 39,1%; p = 0,003) und der klinische Verlauf ist signifikant länger (27,8 ± 19,3 vs. 19,9 ± 23,1 Tage; p < 0,001). Die Qualität der Behandlung der
Beckenfraktur, gemessen an Morbidität (18,6% vs. 14,6%; p = 0,610) und Mortalität (7,0% vs. 2,6%; p = 0,108), zeigt jedoch keine Unterschiede. Schlussfolgerung Verletzungsschwere und
Komplexität der Beckenfraktur sind bei „floating-hip“-Verletzungen signifikant höher, ohne jedoch die resultierende Behandlungsqualität zu beeinträchtigen. Eine
„Femur-first“-Behandlungsstrategie wird von uns und in der Literatur bevorzugt. In einem Flussdiagramm werden dementsprechende Algorithmen für die Notfallbehandlung und die endgültige
Versorgung vorgeschlagen.
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Affiliation(s)
- Christof Karl Audretsch
- Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Alexander Trulson
- Abteilung für Unfallchirurgie, Orthopädie und Allgemeinchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Ulrich Stöckle
- Centrum für Muskuloskeletale Chirurgie, Charite University Hospital Berlin, Berlin, Deutschland
| | - Tina Histing
- Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Markus Alexander Küper
- Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Steven C. Herath
- Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
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Nohmi S, Oishi H, Sakamoto Y. Posterior hip fracture-dislocation associated with posterior wall fracture of the acetabulum and ipsilateral comminuted trochanteric fracture of the femur: A case report. Int J Surg Case Rep 2022; 94:107075. [PMID: 35427888 PMCID: PMC9026913 DOI: 10.1016/j.ijscr.2022.107075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/09/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Traumatic posterior dislocation of the hip is often associated with fractures of the femoral head and posterior wall of the acetabulum. However, hip fracture-dislocation that includes the posterior wall of the acetabulum and the ipsilateral femoral trochanter is rare. There is no consensus on the bone that should be operated on first, the operative position, and the choice of implant for femoral fixation. Case presentation A 67-year-old man was brought to our emergency department after a 2-m fall. He was diagnosed with a hip fracture-dislocation associated with posterior wall acetabular fracture and ipsilateral femoral trochanteric fracture. Surgical reconstruction was performed with intramedullary nail (IMN) fixation of the femoral trochanteric lesion, followed by anatomically rigid acetabular fixation in the lateral decubitus position. At the 5-year follow-up after the injury, the patient showed good objective and subjective clinical outcomes. Clinical discussion Fixing the femur first could allow an easier reduction and traction. The lateral decubitus position was useful, because fixation of the femur and the acetabulum could be performed without changing the position. When fixing the femoral trochanteric lesion, attention was paid to reduce the anteromedial cortex of the proximal fragment extramedullarly to the distal fragment to prevent complications such as cutout and implant breakage. Conclusion Anatomically rigid fixation of the posterior wall of the acetabulum secondary to IMN fixation of the femur, with anteromedial cortical support in the lateral decubitus position, could achieve good objective and subjective clinical outcomes. We report a case of posterior hip fracture-dislocation with fractures of posterior wall and ipsilateral femoral trochanter This is a rare clinical presentation For treatment, femoral intramedullary nail fixation is performed first Then, acetabular posterior wall fixation is performed in lateral decubitus position Anteromedial cortex of proximal fragment is reduced extramedullarly to distal fragment
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Affiliation(s)
- Shuya Nohmi
- Department of Orthopaedic Surgery, Misawa City Hospital, 164-65 Horiguchi, Misawa, Misawa-shi, Aomori 033-0022, Japan.
| | - Hirotaka Oishi
- Department of Orthopaedic Surgery, Hachinohe City Hospital, 3-1-1 Tamukai, Hachinohe-shi, Aomori 031-8555, Japan
| | - Yukiko Sakamoto
- Department of Orthopaedic Surgery, Towada City Central Hospital, 14-8 Nishi12-bancho, Towada-shi, Aomori 034-0093, Japan
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Saini MK. "Floating Hip" and "Floating Knee" Associated with Hip Dislocation, Sciatic Nerve Palsy, and Patella Fracture: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00057. [PMID: 35202023 DOI: 10.2106/jbjs.cc.21.00642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
CASE We report a very rare case of simultaneous ipsilateral floating hip and floating knee (SIFHFK) injury with the neck of the femur and patella fracture and hip dislocation associated with sciatic nerve injury in a 45-year-old man after a road traffic accident. We adopted a staged approach for surgical fixation of the fractures after stabilization. At the latest 2 years follow-up, the patient was asymptomatic with satisfactory clinical outcome. CONCLUSION SIFHFK injuries present a challenging and emergent clinical scenario and require extensive clinical experience, careful planning, and multidisciplinary teamwork because of the paucity of specific treatment protocols for the treatment of this complex injury.
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Affiliation(s)
- Mukesh Kumar Saini
- Arthroplasty division, Department of Orthopaedics, Star Hospitals, Hyderabad, India
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Floating hip with floating acetabulum and bilateral pelvis fractures. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Perumal R, Valleri DP, Yalavarthi RK, Tumati SB, Jayaramaraju D, Shanmuganathan R. How Safe is Antegrade Femoral Nailing in Ipsilateral Acetabulum Fractures Requiring Kocher-Langenbeck Approach? An Analysis of 23 Fractures. Indian J Orthop 2021; 56:592-600. [PMID: 35342518 PMCID: PMC8921365 DOI: 10.1007/s43465-021-00544-w] [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: 10/10/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The ipsilateral acetabulum and femur fracture (IAFF) is an uncommon entity. This combination challenges the surgeon in the optimal management of each injury component, fixation sequence, surgical approaches, implant choices and complications. Inappropriate approach for one fracture may affect the fixation of another or modify the overall outcome. In this perspective, we aim to analyze our results in patients who underwent acetabulum fixation with Kocher-Langenbeck (K-L) approach and antegrade femur nailing (AFN), emphasizing the incidence of infection, skin necrosis and heterotopic ossification (HO). METHODS During the five years, 22 patients with 23 IAFF (mean age of 36.5 years) were treated operatively. All the patients underwent K-L approach for acetabulum fixation and AFN for femur fracture. All the patients were treated under the supervision of a pelvi-acetabular trauma consultant. Demographic data, injury, surgical, and postoperative details were collected. The quality of acetabular reduction was evaluated using Matta's criteria. The radiological outcome, obtained at final follow-up, was graded according to Matta's criteria. Functional outcome was evaluated by Merle d'Aubigné and Postel system. HO was graded according to the Brooker system. Complications recorded were DVT, skin necrosis, infection, arthritis, HO, AVN and need for additional surgery. RESULTS Out of 23, 11 had posterior dislocation, 6 had quadrilateral plate injury with central protrusion and six without dislocation. Femur fractures include 9-midshaft, 4-proximal third, 3-distal third, 3-trochanteric fractures and 4-segmental fractures. There were 11 elementary and 12 associated acetabulum fractures. 21 fractures underwent staged-fixation. Single-stage fixation was done in 2. In all cases treated with staged-fixation, AFN was done first. The mean duration of follow-up was 28 months (16-57). All femur fractures united with a mean union time of 21.3 weeks (11-37). The radiological outcome was excellent in 13, good in 4, fair in 3 and poor in 3. The functional outcome was excellent in 3, good in 11, fair in 4 and poor in 4 patients. None had skin necrosis. Three patients had infection. 14 (60.8%) hips had HO, with clinically significant HO (grade 4) in 2(8.6%). Six (26%) patients had arthritic changes. Four (17.3%) hips had avascular necrosis. CONCLUSION AFN is a viable option in IAFFs requiring a K-L approach under the supervision of a pelvi-acetabular surgeon. This combined approach per se does not demonstrate an increased risk of infection, wound healing problems or HO. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00544-w.
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Affiliation(s)
- Ramesh Perumal
- Division of Orthopaedics and Trauma, Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals, 313, Mettupalayam Road, Coimbatore, 641043 India
| | - Durga Prasad Valleri
- Division of Orthopaedics and Trauma, Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals, 313, Mettupalayam Road, Coimbatore, 641043 India
| | - Rakesh Kiran Yalavarthi
- Division of Orthopaedics and Trauma, Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals, 313, Mettupalayam Road, Coimbatore, 641043 India
| | - Shanmuka Babu Tumati
- Division of Orthopaedics and Trauma, Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals, 313, Mettupalayam Road, Coimbatore, 641043 India
| | - Dheenadhayalan Jayaramaraju
- Division of Orthopaedics and Trauma, Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals, 313, Mettupalayam Road, Coimbatore, 641043 India
| | - Rajasekaran Shanmuganathan
- Division of Orthopaedics, Trauma and Spine Surgery, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, 641043 India
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Floating hip in polytraumatized patients: complications, mechanism of injury, and surgical strategy. INTERNATIONAL ORTHOPAEDICS 2021; 46:361-368. [PMID: 34779899 DOI: 10.1007/s00264-021-05262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Floating hip fractures are severe and rare injuries with high complication rate and lack of standard management. The purpose of this retrospective study was to review the outcomes of a case series of polytraumatized patients with floating hip injuries, in order to describe the relationship between complication rate and floating hip injury type, the pathomechanism of injury, and the surgical treatment strategy. METHODS Forty-five patients with floating hip injuries were analyzed. Complication rate, mechanism of injury, and surgical strategy (damage control orthopedics, stages of internal fixation) were recorded. Fractures were classified using the Mueller system for floating hips and AO/OTA system for the other fractures. RESULTS Of the 45 patients with floating hip injuries, 23 (51.1%) developed complications. The results revealed that the complication rate was associated with the instability and type of the pelvic or acetabular fracture (61-C AO/OTA pelvic fracture [73.3%; p = 0.04], 62-B AO/OTA acetabular fracture [88.8%; p = 0.03]). Vertical shear (VS) pelvic fractures were related to middle-distal femoral fractures and lateral compression/anteroposterior compression (LC/APC) pelvic lesions were associated to proximal femoral fractures (p = 0.012). CONCLUSIONS Complications were associated with the severity and instability of the pelvic and acetabular type of fractures. The pathomechanism causing Mueller type B and C floating hip injuries was illustrated. A two-stage "femur first" surgical approach was the preferred one for definite internal fixation of fractures.
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Meena UK, Bansal MC, Behera P, Goyal D, Kumar R. Concomitant ipsilateral acetabular and femoral fractures – an appraisal of outcomes and complications in 34 patients. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Concomitant ipsilateral femoral and acetabular fractures are complex injuries which result from high-velocity trauma. Surgical treatment is the accepted management of such injuries. The objectives of this study were to evaluate the outcomes and study the complications in patients treated for concomitant ipsilateral acetabular and femoral fractures (type ‘B’ floating hip injuries).
This retrospective study was conducted at a tertiary care teaching hospital on patients operated for type B floating hip injuries, who had completed a minimum of one-year follow-up after the surgery and whose complete records were available. Those with floating hip injuries with pelvic fractures were excluded. All patients were operated on the femoral side first, followed by the acetabular side.
34 patients were included ; most of them were young males. A road traffic accident was the most common mode, with a dashboard injury being the most common mechanism of injury. No association between the type of acetabular and femoral fractures was found. The clinical (measured with Harris hip score) and radiological (Matta’s method) outcomes at the latest follow-up were excellent or good in >60% cases and had a significant association with the quality of reduction on the post-operative radiographs. Com- plications were seen in 12 out of the 34 patients.
Type B floating hips injuries can be managed well with acceptable short-term results by following a femur first strategy. However, patients must be informed of the possible complications and the probabilities of poorer outcomes when compared to isolated acetabular or femoral fractures.
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Hammad AS, Rashed RA, Abu-Sheasha G, El-Bakoury A. Functional outcome and health-related quality of life following ipsilateral femoral and acetabular fractures: a retrospective analysis. SICOT J 2021; 7:52. [PMID: 34709174 PMCID: PMC8552691 DOI: 10.1051/sicotj/2021050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/21/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The combination of ipsilateral femoral and acetabular fractures is known in the literature as the "Floating hip injury". The primary aim of this study is to assess both generic and specific patient-reported outcomes and the factors affecting the quality of life in patients sustaining this injury, while the secondary aim was to assess the injury patterns and the associated complications. METHODS A retrospective study including 27 patients according to specific inclusion and exclusion criteria. EQ5D5L and Oxford hip score (OHS) were used. The mean age was 28 years (±10.1 SD) and 21 patients (77.8%) were males. The mean follow-up was 7 years (± 3.1 years SD). RESULTS Median OHS was 46.5 (IQR: 31.5-48). The median EQ5D score was 0.919 (95% CI: 0.601-1). The mean EQ5D index value was 0.679 ± 0.442 (95% CI: 0.492-0.865). In this young cohort of patients, this drop in the mean EQ5D index value has led to a loss of a mean of 2.2 Quality-adjusted Life Years (QALYs). Through multivariate analysis, we found that the quality of life was mainly affected by the occurrence of end-stage arthritis, the presence of non-recovered traumatic sciatic nerve injury, and the occurrence of infection. CONCLUSIONS Our findings show that the quality of life of those patients was significantly affected. These findings can be beneficial in counselling patients sustaining this complex injury and could be helpful in the discussion of the prognosis and in planning postoperative rehabilitation and support.
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Affiliation(s)
- Abdullah Said Hammad
- Associate Professor Orthopaedic Surgery and Traumatology, Elhadra University Hospital, Faculty of Medicine Alexandria Egypt
| | - Ramy Ahmed Rashed
- Clinical Fellow Trauma and Orthopaedics, University Hospitals Plymouth NHS Trust Plymouth PL68DH UK
| | - Ghada Abu-Sheasha
- Associate Professor of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University Alexandria Egypt
| | - Ahmed El-Bakoury
- Lecturer of Orthopaedics and Trauma, University of Alexandria Alexandria Egypt
- Consultant Orthopaedic Surgeon, University Hospitals Plymouth NHS Trust Plymouth PL68DH UK
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Cech A, Rieussec C, Kerschbaumer G, Seurat O, Corbet C, Vibert B, Tronc C, Ruatti S, Bouzat P, Tonetti J, Boudissa M. Complications and outcomes in 69 consecutive patients with floating hip. Orthop Traumatol Surg Res 2021; 107:102998. [PMID: 34214653 DOI: 10.1016/j.otsr.2021.102998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip. HYPOTHESIS A standardized strategy with specialised multidisciplinary management is associated with a low mortality rate. METHODS Consecutive patients who had surgery to treat floating hip between January 2010 and December 2019 were included in this single-centre retrospective study. Epidemiological, clinical, and radiological data were collected and analysed. Patients were managed according to a standardised strategy adapted to the haemodynamic status and type of floating hip (type A, femoral and pelvic ring fractures; type B, femoral and acetabular fractures; and type C, femoral, acetabular, and pelvic ring fractures). The clinical outcome at last follow-up was determined by a telephone interview, based on the Majeed and Oxford scores, sports resumption, and work resumption. To assess the radiological outcomes, we applied Matta's criteria for the acetabulum and Tornetta's criteria for the pelvic ring. RESULTS We included 69 patients with a mean age of 38.5 years. Among them, 39 (57%) had haemodynamic instability requiring embolisation (n=15, 22%) or multiple blood transfusions (n=24, 35%). Type A injuries predominated (n=57, 83%). The need for multiple blood transfusions was significantly associated with type C floating hip, underlining the risk of heavy bleeding with this injury. Two (3%) patients died. When management was complete, the reduction was anatomical or satisfactory for 76% (13/17) of the acetabula according to Matta's criteria (maximum residual displacement <3mm) and for 85% (56/66) of the pelvic rings according to Tornetta's criteria (maximum residual displacement <10mm). One or more complications occurred in 45 (65%) patients. After a mean follow-up of 5 years, the mean Oxford Hip Score in patients with acetabular fractures was 35.5 and the mean Majeed score in patients with pelvic ring fractures was 71.5. Only 30% of patients were able to resume physical activities at the former level and to return to their former professional activities. CONCLUSION Type C floating hip, which combines fractures of the pelvic ring and acetabulum, carries a high risk of bleeding. Special attention should be directed to the reduction of pelvic ring fractures, to avoid malunion. Acetabular fractures that are complex in the Letournel classification carry a risk of imperfect reduction. The results of this study confirm the severity of these rare injuries and the need for specialised multidisciplinary management according to a standardised strategy that is appropriate for the haemodynamic status and type of floating hip (A, B, or C). LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Alexandre Cech
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Clémentine Rieussec
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Gaël Kerschbaumer
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Olivier Seurat
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Clémentine Corbet
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Benoît Vibert
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Camille Tronc
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Sébastien Ruatti
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Pierre Bouzat
- Service de réanimation et déchocage, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France
| | - Jérôme Tonetti
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France; TIMC-IMAG lab, University Grenoble Alpes, CNRS UMR 5525, 38700 La Tronche, France
| | - Mehdi Boudissa
- Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Grenoble, Université Grenoble Alpes, 38700 La Tronche, France; TIMC-IMAG lab, University Grenoble Alpes, CNRS UMR 5525, 38700 La Tronche, France.
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Anand V, Deviprasad, Praba K, Babar S, Babu M. Ipsilateral floating hip and knee, or floating lower limb - A rare case report. Trauma Case Rep 2021; 31:100390. [PMID: 33365379 PMCID: PMC7749423 DOI: 10.1016/j.tcr.2020.100390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Ipsilateral floating hip and knee injuries at the same time are very rare injuries, occurring due to high velocity trauma. With a small number of such case reports, the treatment guidelines regarding surgical fixation are yet to be formulated. CASE REPORT We report an interesting case of hip dislocation, comminuted acetabular fracture, intertrochanteric and shaft of femur fracture and both bones leg fracture ipsilaterally. Open reduction of hip, antegrade femoral nailing with recon nail and closed tibial nailing was done in a single setting. Acetabular fracture was treated non-operatively. CONCLUSION Patient's general condition, co-morbid status, fracture pattern and the surgical expertise of the trauma team should guide the definitive treatment and its sequence. Early fixation of long bones is warranted and acetabular fixation can be done in second stage.
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Affiliation(s)
- Vijay Anand
- Department of Orthopaedics, SRM Medical College and Research Centre, India
| | - Deviprasad
- Department of Orthopaedics, SRM Medical College and Research Centre, India
| | - Kalyani Praba
- Department of Physiology, SRM Medical College and Research Centre, Kattankulathur, Tamilnadu, India
| | - Suraj Babar
- Department of Orthopaedics, SRM Medical College and Research Centre, India
| | - Mahesh Babu
- Department of Orthopaedics, Government Medical College, Villupuram, Tamilnadu, India
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Simultaneous Ipsilateral Floating Hip and Knee: A Complex Combination and Difficult Surgical Challenge. Case Rep Orthop 2020; 2020:9197872. [PMID: 32095304 PMCID: PMC7035533 DOI: 10.1155/2020/9197872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/16/2019] [Accepted: 01/10/2020] [Indexed: 12/26/2022] Open
Abstract
Simultaneous ipsilateral floating hip and floating knee are extremely rare. To the best of our knowledge, only four cases have been described in the literature. This uncommon injury is mostly caused by high-velocity impact and associated with life-threatening lesions. We report a unique case of concomitant ipsilateral floating hip and floating knee following road traffic accident. The patient presented ipsilateral hip dislocation and acetabular, femoral, and tibial fractures associated with chest trauma. The aim of this report is to highlight the severity and rarity of this combination and to describe the therapeutic recommendations.
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16
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Ebeling PA, Clark C, Erwin D, Beale K, Dent DL. Femoral Head Dislocation into the Rectum Following Blunt Trauma. Cureus 2019; 11:e4596. [PMID: 31309021 PMCID: PMC6609309 DOI: 10.7759/cureus.4596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Traumatic hip dislocations require prompt diagnosis and treatment to prevent avascular necrosis of the femoral head. This injury is further complicated when there is an ipsilateral femur fracture. Here, we present what is likely the first reported case of a patient with traumatic hip dislocation and ipsilateral femur fracture with transrectal displacement of the femoral head. The patient presented to a level one trauma center in 2006 as a transfer from another facility after being thrown from a pickup truck. Upon initial evaluation, a foreign body was palpated in the rectum. Computed tomography (CT) imaging showed that the right femoral head was lodged within the pelvis. In the operating room, an exploratory laparotomy was performed, and anoscopy confirmed the placement of the femoral head within the rectal lumen. The femoral head was extracted from the rectum transanally. The operation was abbreviated, as the patient became hemodynamically unstable, and he was taken to the intensive care unit. He returned to the operating room the following day for a repeat washout and proximal diversion. Despite numerous orthopedic procedures and operative washouts, he ultimately underwent a right hip disarticulation. Physicians should be aware that intracorporeal femoral head displacement is possible in select patients who have experienced a high-energy trauma mechanism. This is a complicated, highly morbid injury that poses various management challenges to orthopedic and acute care surgeons.
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Affiliation(s)
- Peter A Ebeling
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Clarence Clark
- Surgery, Morehouse School of Medicine and Grady Memorial Hospital, Atlanta, USA
| | - Dylan Erwin
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Katherine Beale
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Daniel L Dent
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
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Abstract
BACKGROUND The term "floating" is used in orthopedic literature to describe certain patterns of skeletal injuries that share one common character which is disruption and discontinuity of bones above and below a joint. The first time used in orthopedic literature being in late 1970 to describe a type of elbow injury. Later the word was used increasingly and applied to a variety of injuries affecting the knee, shoulder, hip, forearm, hand, and ankle. Currently, there are about 12 different skeletal injuries described as floating. OBJECTIVES The aim of this article was to define the term "floating" used in traumatic orthopedics and to discuss its history, mechanism of injury in each region, treatment and outcomes based on the currently available literature. As there were many separate articles describing different sites of floating injuries, this review aimed to summarize all floating injuries into 1 article.
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Affiliation(s)
| | | | - Ying Qin
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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18
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Ipsilateral Acetabular Fracture with Displaced Femoral Head and Femoral Shaft Fracture: A Complex Floating Hip Injury. Case Rep Orthop 2018; 2018:4937472. [PMID: 30057840 PMCID: PMC6051121 DOI: 10.1155/2018/4937472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/12/2018] [Indexed: 11/17/2022] Open
Abstract
Floating hip injuries involving the acetabulum, femoral head, and the femoral shaft are a very rare presentation. A complex floating hip injury comprising of an ipsilateral acetabular fracture associated with a displaced femoral head fracture and a femoral shaft fracture following a high-velocity road traffic accident presented to us where all the fractures were addressed with internal fixation during the primary surgery. Postoperatively, the patient suffered a dislocation of the femoral head which eventually went on to avascular necrosis at 5 months from the initial presentation. Then, the patient underwent a total hip replacement with an acetabular reconstruction following which he went on to have a good functional outcome. Our experience in dealing with such a complex case shows that it is difficult to set a protocol for such injuries and they need to be addressed on a case-to-case basis depending on the complexity of the injury.
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Treatment and Complications of Patients With Ipsilateral Acetabular and Femur Fractures: A Multicenter Retrospective Analysis. J Orthop Trauma 2017; 31:650-656. [PMID: 28742784 DOI: 10.1097/bot.0000000000000966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to review the treatment of patients with ipsilateral acetabular and femur fractures to provide descriptive demographic data, injury pattern classification, treatment, and evaluate the complication profile reflective of current practices. STUDY DESIGN Multicenter retrospective cohort. SETTING Eight Level 1 Trauma Centers. PATIENTS/PARTICIPANTS One hundred one patients met inclusion criteria. INTERVENTION Surgical treatment of both the acetabular and femur fractures. MAIN OUTCOME MEASUREMENTS The complications evaluated include avascular necrosis, heterotopic ossification, posttraumatic arthritis, deep venous thrombosis, pulmonary embolism and superficial/deep infection, fracture union, and secondary surgeries. RESULTS Forty-three patients had 31 type fractures (29A; 11B, and 3C), 60 had 32 type (37A, 8B; 15C), and 8 had 33 type (1A, 4B, 3C) femur fractures; 10 patients had combinations involving more than 1 femur fracture pattern. There were 35 62A type fractures, 47 62B, and 19 62C acetabular fractures. Age of 45 or older was associated with marginal impaction (P = 0.001). The aggregate infection rate was 17%. More than 30% of patients required secondary surgeries. The rate of avascular necrosis was higher in acetabular fractures combined with proximal femur fractures (P < 0.05). The rate of deep venous thrombosis was associated with increased age and time to surgical fixation (P < 0.05). CONCLUSIONS We report the largest review of the surgical treatment and complications of ipsilateral acetabular and femoral fractures. This study provides useful information regarding the complications and provides some treatment recommendations regarding these injuries. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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20
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Abstract
AIM To describe our experience in treating patients diagnosed with floating hip injury and to communicate the outcomes achieved and the rate of complications. A secondary aim is to compare the results of this group in terms of quality of life with those of patients presenting with a fracture either of the pelvis or of the acetabulum, but in which the femoral segment is not involved. PATIENTS AND METHODS This is a descriptive study of the patients diagnosed with floating hip injury (25 patients) who were treated at our hospital between 2004 and 2007, with a minimum follow-up of seven years. The results are compared with those of a control group of 56 patients diagnosed with an isolated pelvic or acetabular injury. We describe the injuries and the associated lesion. The patients' quality of life was assessed using the EUROQOL tool. RESULTS Among the floating hip group of patients, three suffered an additional arterial lesion and were later treated with a supracondylar amputation. Seven patients presented heterotopic ossification. No significant difference was observed between the study and control groups, according to the EUROQOL tool, although the scores for every dimension were lower among the floating hip patients. Among the patients in the control group, the quality of life scores were also affected in every dimension of the EUROQOL scale. DISCUSSION AND CONCLUSIONS The addition of a femoral fracture to a pelvic or acetabular injury, the so-called floating hip, is a devastating injury which has an important impact on patients' quality of life, going beyond that experienced by patients with isolated injuries. Nevertheless, our results did not reflect statistically significant differences in the quality of life among the three groups analyzed: isolated fractures, floating hip and floating hip resulting in amputation.
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Affiliation(s)
- Plácido Zamora-Navas
- Hospital Clínico Universitario Virgen de la Victoria, Malaga, Spain; University of Malaga, School of Medicine, Malaga, Spain.
| | | | - Juan Ramón Cano
- Hospital Universitario Costa del Sol. Marbella, Malaga, Spain
| | - Enrique Guerado
- University of Malaga, School of Medicine, Malaga, Spain; Hospital Universitario Costa del Sol. Marbella, Malaga, Spain
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21
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22
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Song W, Zhou D, He Y. Biomechanical characteristics of fixation methods for floating pubic symphysis. J Orthop Surg Res 2017; 12:38. [PMID: 28270223 PMCID: PMC5341422 DOI: 10.1186/s13018-017-0541-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 02/23/2017] [Indexed: 01/13/2023] Open
Abstract
Background Floating pubic symphysis (FPS) is a relatively rare injury caused by high-energy mechanisms. There are several fixation methods used to treat FPS, including external fixation, subcutaneous fixation, internal fixation, and percutaneous cannulated screw fixation. To choose the appropriate fixation, it is necessary to study the biomechanical performance of these different methods. The goal of this study was to compare the biomechanical characteristics of six methods by finite element analysis. Methods A three-dimensional finite element model of FPS was simulated. Six methods were used in the FPS model, including external fixation (Ext), subcutaneous rod fixation (Sub-rod), subcutaneous plate fixation (Sub-plate), superior pectineal plate fixation (Int-sup), infrapectineal plate fixation (Int-ifa), and cannulated screw fixation (Int-scr). Compressive and rotational loads were then applied in all models. Biomechanical characteristics that were recorded and analyzed included construct stiffness, micromotion of the fracture gaps, von Mises stress, and stress distribution. Results The construct stiffness of the anterior pelvic ring was decreased dramatically when FPS occurred. Compressive stiffness was restored by the three internal fixation and Sub-rod methods. Unfortunately, rotational stiffness was not restored satisfactorily by the six methods. For micromotion of the fracture gaps, the displacement was reduced significantly by the Int-sup and Int-ifa methods under compression. The internal fixation methods and Sub-plate method performed well under rotation. The maximum von Mises stress of the implants was not large. For the plate-screw system, the maximum von Mises stress occurred over the region of the fracture and plate-screw joints. The maximum von Mises stress appeared on the rod-screw and screw-bone interfaces for the rod-screw system. Conclusions The present study showed the biomechanical advantages of internal fixation methods for FPS from a finite element view. Superior stabilization of the anterior pelvic ring and fracture gaps was obtained by internal fixation. Subcutaneous fixation had satisfactory outcomes as well. Sub-rod fixation offered good anti-compression, while the Sub-plate fixation provided favorable anti-rotational capacity.
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Affiliation(s)
- Wenhao Song
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Ji'nan, Shandong, People's Republic of China
| | - Dongsheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Ji'nan, Shandong, People's Republic of China.
| | - Yu He
- Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Ji'nan, Shandong, People's Republic of China.
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Verettas DA, Chloropoulou PP, Drosos G, Vogiatzaki T, Tilkeridis K, Kazakos K. Simultaneous Periprosthetic Fractures of the Femur and the Acetabulum After Bipolar Hip Arthroplasty. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:973-976. [PMID: 28003639 PMCID: PMC5207013 DOI: 10.12659/ajcr.900435] [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] [Indexed: 11/09/2022]
Abstract
Patient: Female, 68 Final Diagnosis: Periprosthetic fractures of the acetabulum and femur after bipolar hip arthroplasty Symptoms: Inability to walk Medication: — Clinical Procedure: Revision cup and internal fixation femur Specialty: Orhopedics and Traumatology
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Affiliation(s)
| | | | - Georgios Drosos
- Department of Orthopedic Surgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theodosia Vogiatzaki
- Department of Anesthesiology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Konstantinos Kazakos
- Department of Orthopedic Surgery, Democritus University of Thrace, Alexandroupolis, Greece
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Ipsilateral Acetabular and Femoral Neck and Shaft Fractures. Case Rep Orthop 2015; 2015:351465. [PMID: 26171267 PMCID: PMC4478406 DOI: 10.1155/2015/351465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/04/2015] [Indexed: 11/26/2022] Open
Abstract
Floating hip injuries and ipsilateral femoral neck and shaft fractures are rare. Additionally, the simultaneous occurrence of these injuries is extremely rare, and only one case report of the simultaneous occurrence of these injuries has been published. Here, we report the case of a patient with ipsilateral acetabular and femoral neck and shaft fractures following a suicide attempt. The patient experienced nonunion of the femoral neck and shaft after the initial operation and therefore underwent reconstruction using a femoral head prosthesis with a long stem and interlocking screws. Our procedure may be used in primary and/or secondary reconstruction for ipsilateral acetabular and femoral neck and shaft fractures.
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25
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26
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Tiedeken NC, Saldanha V, Handal J, Raphael J. The irreducible floating hip: a unique presentation of a rare injury. J Surg Case Rep 2013; 2013:rjt075. [PMID: 24964321 PMCID: PMC3852630 DOI: 10.1093/jscr/rjt075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A floating hip injury occurs in the setting of poly-trauma and is a rare and difficult problem to manage. Floating hip injuries require vigilant attention not only to the osseous injuries but also the surrounding compartments and soft tissue envelope. We report the case of a 35-year-old male with a lower extremity posterior wall acetabular fracture, ipsilateral femoral shaft fracture and a postero-superior hip dislocation. Closed reduction failed, necessitating an open reduction internal fixation of his hip dislocation and acetabular fracture. The patient then developed a thigh compartment syndrome requiring a fasciotomy. Despite the obvious bony injuries, orthopedic surgeons must be vigilant of the neurovascular structures and soft tissues that have absorbed a great amount of force. A treatment plan should be formulated based on the status of the overlying soft tissue, fracture pattern and the patient's physiologic stability.
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Affiliation(s)
- Nathan C Tiedeken
- Department of Orthopaedic Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Vilas Saldanha
- Department of Orthopaedic Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - John Handal
- Department of Orthopaedic Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - James Raphael
- Department of Orthopaedic Surgery, Albert Einstein Medical Center, Philadelphia, PA, USA
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Bishop JA, Cross WW, Krieg JC, Chip Routt ML. Antegrade femoral nailing in acetabular fractures requiring a Kocher-Langenbeck approach. Orthopedics 2013; 36:e1159-64. [PMID: 24025007 DOI: 10.3928/01477447-20130821-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ipsilateral displaced acetabular and femoral shaft fractures represent a dilemma for orthopedic surgeons because antegrade femoral nailing may complicate a Kocher-Langenbeck acetabular exposure. The goals of this study were to review the results of ipsilateral femoral and acetabular fractures treated with antegrade femoral nailing and a Kocher-Langenbeck approach and to evaluate the assertion that this treatment strategy is associated with increased morbidity. This was a retrospective cohort study at a regional Level I trauma center. Sixteen patients with a femoral fracture treated with antegrade nailing and an ipsilateral acetabular fracture treated with a Kocher-Langenbeck approach were identified. One patient died as a result of his injuries, and 2 were not available for long-term follow-up. One had a deep infection requiring irrigation, debridement, and intraveonous antibiotics. One patient developed a hematoma requiring irrigation and debridement. At final follow-up, 2 patients had no heterotopic ossification about the hip, 4 had Brooker class I heterotopic ossification, 3 had Brooker class II heterotopic ossification, 2 had Brooker class III heterotopic ossification, and 2 patients had Brooker class IV heterotopic ossification requiring excision. Ipsilateral femoral and acetabular fractures represent a rare and severe injury constellation. Antegrade nailing of the femur with ipsilateral Kocher-Langenbeck exposure for fixation of the acetabulum was not associated with excessive rates of wound-healing complications, but the incidence of heterotopic ossification was increased.
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28
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Yashavantha Kumar C, Nalini KB, Nagaraj P, Jawali A. Ipsilateral Floating Hip and Floating Knee - A Rare Entity. J Orthop Case Rep 2013; 3:3-6. [PMID: 27298908 PMCID: PMC4719252 DOI: 10.13107/jocr.2250-0685.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Ipsilateral floating hip and floating knee are very rare injuries. These injuries so uncommon that only three cases of similar kind have been reported. These injuries are due to high velocity injuries following motor vehicle accidents. Management of such complex injuries is a challenging task even in experienced hands as there are no standard treatment guidelines for such fractures. Case Report: We hereby report a 20 yr old male who sustained ipsilateral floating hip and ipsilateral floating knee injuries following motor vehicle accident. Patient was stabilized initially and later taken up for surgery. Patient was treated with interlocking nail for femur and tibia in the same sitting whereas acetabulam fracture was managed conservatively. At five months all the fractures united well with restoration of good range of motion in both hip and knee Conclusion: Ipsilateral floating knee and floating hip are very rare injuries seen following high velocity motor vehicle accidents. There are no standard guidelines for treatment of those fractures as only a few cases of similar kind have been reported in literature. Early fixation and aggressive mobilization ensures fracture union and fewer complications.
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Affiliation(s)
| | - K B Nalini
- Dept of Orthopaedics M S Ramiah Medical College, Bangalore, India-560054
| | - Prashanth Nagaraj
- Dept of Orthopaedics M S Ramiah Medical College, Bangalore, India-560054
| | - Abhijith Jawali
- Dept of Orthopaedics M S Ramiah Medical College, Bangalore, India-560054
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Abstract
BACKGROUND To perform a descriptive study of the course, treatment decisions, complications, and outcome of patients suffering simultaneous ipsilateral fractures of the femur and pelvis. METHODS Medical records and radiographs of 57 patients were reviewed retrospectively. RESULTS The average follow-up was 28 months. Fifteen patients (26%) had an acetabular fracture, 17 (30%) had a pelvic ring fracture, and 25 (44%) had both fractures concomitant with the ipsilateral femoral fracture. Eighty percent of acetabular fractures and 55% of pelvic ring fractures were treated surgically. Femur fractures underwent operation in 94% of cases. When multiple operative settings were used, the femur fracture was always fixed at the first operation. Complications included deep venous thrombosis (DVT) (12%), heterotopic ossification (HO) (34%), femoral head avascular necrosis (AVN) (2%), osteoarthritis (OA) (16%), and traumatic sciatic nerve palsy (33%). At least partial nerve palsy resolution occurred in 53% of patients. CONCLUSIONS Ipsilateral injuries to the femur and the pelvis or acetabulum ("floating hip") are severe injuries usually caused by high-energy trauma. The acetabulum and pelvic ring are more commonly fractured together than either alone. The femur fracture will most commonly be addressed first, as in 65% of our cases in which both components were addressed at the same setting, and 100% of cases in which they were addressed in separate settings. Delays of surgery were common because of severity of systemic trauma. Surgeons should be aware of the high incidence of sciatic nerve palsy as well as treatment options and potential complications associated with this devastating combination of injuries.
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Ng ABY, Soong VKY, Maguire MP, Hopgood P, Shepard GJ. Concomitant ipsilateral floating hip and floating knee injuries: a unique injury and review of the literature. Int J Clin Pract 2007; 61:1585-7. [PMID: 17596186 DOI: 10.1111/j.1742-1241.2006.00868.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Suzuki T, Shindo M, Soma K. The floating hip injury: which should we fix first? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2006. [DOI: 10.1007/s00590-006-0081-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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