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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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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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Xu Y, Lv M, Yu SQ, Liu GP. Closed reduction of hip dislocation associated with ipsilateral lower extremity fractures: A case report and review of the literature. World J Clin Cases 2022; 10:12654-12664. [PMID: 36579117 PMCID: PMC9791526 DOI: 10.12998/wjcc.v10.i34.12654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/17/2022] [Accepted: 11/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Traumatic hip dislocation usually occurs following high-velocity trauma. It is imperative that the dislocation be reduced in a timely manner, especially in a closed manner, as an orthopedic emergency. However, closed reduction can hardly be achieved in patients who also have ipsilateral lower extremity fractures. Herein, we focus on hip dislocation associated with ipsilateral lower extremity fractures, excluding intracapsular fractures (femoral head and neck fractures), present an early closed hip joint reduction method for this injury pattern, and review the literature to discuss the appropriate closed reduction technique for this rare injury pattern.
CASE SUMMARY We report a case of a 37-year-old male who sustained a left acetabular posterior wall fracture, an ipsilateral comminuted subtrochanteric fracture and dislocation of the hip. The hip dislocation was reduced urgently in a closed manner using the joy-stick technique with a T-shaped Schanz screw. The fractures were reduced and fixed as a 2nd-stage surgery procedure. At the 17-month postoperative follow-up, the patient had full range of motion of the affected hip.
CONCLUSION Closed reduction of a hip dislocation associated with ipsilateral lower extremity fractures is rarely achieved by regular maneuvers. Attempts at closed reduction, by means of indirectly controlling the proximal fracture fragment or reconstructing the femoral leverage rapidly with the aid of various external reduction apparatuses, were shown to be effective in some scenarios. Mandatory open reduction is indicated in cases of failed closed reduction, particularly in irreducible dislocations.
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Affiliation(s)
- Yong Xu
- Department of Orthopaedics, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Ming Lv
- Department of Orthopaedics, Zibo Central Hospital, Shandong University, Zibo 255000, Shandong Province, China
| | - Shu-Qiang Yu
- Department of Orthopaedics, The Fourth People's Hospital of Zibo, Zibo 255000, Shandong Province, China
| | - Guang-Ping Liu
- Department of Orthopaedics, Zibo Central Hospital, Shandong University, Zibo 255000, Shandong Province, China
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Alnaser AAMA, Abd‐Elmaged HMA, Mohammed FEA, Abd ALLAH RAAA, Mohamed Ahmed Hussien MA. A bilateral asymmetrical hip dislocation: A rare case report. Clin Case Rep 2022; 10:e6439. [PMID: 36245457 PMCID: PMC9548659 DOI: 10.1002/ccr3.6439] [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: 02/28/2022] [Revised: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 11/11/2022] Open
Abstract
A 17‐year‐old male was ejected from the motorcycle and brought to the Emergency Department with bilateral hip dislocation and absence of pelvic or femur fractures or sciatic nerve injury. Closed reduction and postreduction examination were performed with a bilateral stable full range of motion in all directions.
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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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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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8
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Sahito B, Abro A, Kumar V, Hussain B, Ahmed K, Kamboh A, Qadir A, Ali M. Bilateral asymmetrical hip dislocations with acetabulum fractures; a case report. Trauma Case Rep 2021; 32:100453. [PMID: 33778147 PMCID: PMC7985565 DOI: 10.1016/j.tcr.2021.100453] [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: 03/08/2021] [Indexed: 11/26/2022] Open
Abstract
Bilateral hip dislocation is a rare injury and asymmetrical hip dislocations are even very rare entities. We are reporting two cases of bilateral asymmetrical hip dislocations with associated acetabulum fractures. Mechanism of injury in first case was fall from height and in other case road traffic accident. Associated injuries were midshaft femur fracture and sciatic nerve (Peroneal part). Anterior hip dislocation in both cases is reduced closely but posterior hip dislocation in both cases relocated openly due to ipsilateral femur fracture in first case and unstable hip in second case. Acetabulum fractures fixed with reconstruction plate. Postoperative recovery of patient was uneventful except sciatic nerve injury (Peroneal part) lead to foot drop that is supported with ankle foot arthrosis.
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Affiliation(s)
- Badaruddin Sahito
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Awais Abro
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Vijay Kumar
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Bakht Hussain
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Khalil Ahmed
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Azam Kamboh
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Abdul Qadir
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
| | - Maratib Ali
- Department of Orthopaedic Surgery, Dow University of Health Sciences, Ruth K M Pfau Civil Hospital Karachi, Pakistan
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9
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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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10
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Giaretta S, Silvestri A, Momoli A, Micheloni GM. Asymmetric bilateral hip dislocation in young man: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:183-186. [PMID: 30715022 PMCID: PMC6503424 DOI: 10.23750/abm.v90i1-s.8067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 12/14/2022]
Abstract
Bilateral hip dislocation is a rare event, asymmetric dislocation is even rarer. Due to the intrinsic stability of the hip joint this lesions usually follow a high energy trauma. Because of the common associated lesions, the initial clinical assessment should be performed thoroughly. CT scan rather than x-rays offers a complete survey of these possible associated injuries such as thoracic or abdominal bleedings, neurologic lesions or fractures directly associated with the hips dislocations. The first goal should be reduction of the dislocation to prevent avascular necrosis (AVN) of the femoral head and arthritis. We report a case of a young man with right anterior hip dislocation and left posterior hip dislocation with associated fracture of the posterior wall. (www.actabiomedica.it)
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Affiliation(s)
- Stefano Giaretta
- Orthopedic and Traumatology Unit, Ospedale San Bortolo, Vicenza.
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11
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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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12
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DuBois B, Montgomery WH, Dunbar RP, Chapman J. Simultaneous ipsilateral posterior knee and hip dislocations: case report, including a technique for closed reduction of the hip. J Orthop Trauma 2006; 20:216-9. [PMID: 16648704 DOI: 10.1097/00005131-200603000-00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In isolation, dislocations of the hip and knee require emergent reduction to minimize the risks of serious complications, including vascular and neurologic injury, osteonecrosis of the femoral head, and loss of motion and function. With simultaneous dislocation of the ipsilateral hip and knee, as in the situation of hip dislocation with concomitant femoral shaft fracture, reduction of the hip may prove difficult because of the inability to control the femoral segment. In this setting, general anesthesia is commonly required. We present the case of a patient who sustained an ipsilateral hip and knee dislocation who underwent closed reduction of the knee in the emergency department but required general anesthesia and the insertion of Schanz pins in the femur to reduce the hip dislocation.
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Affiliation(s)
- Ben DuBois
- Grossmont Orthopaedic Medical Group, La Mesa, CA, USA
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13
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Ido K, Morita T, Kondo K, Sakamoto T, Asada Y, Hayashi R, Kuriyama S. Severe central fracture-dislocation of the hip migrated deep into the pelvis complicating ileal rupture and ipsilateral comminuted femoral fracture: CT characteristics. Comput Med Imaging Graph 2001; 25:523-5. [PMID: 11679215 DOI: 10.1016/s0895-6111(01)00012-x] [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: 10/18/2022]
Abstract
A case of severe central fracture-dislocation of the hip migrated deep into the pelvis complicating ileal rupture and ipsilateral comminuted fracture of the proximal femur was described. Plain CT images of the pelvis were distinctive and quite useful for evaluating the severity of the injury. Osteomyelitis of the proximal femur occurred soon after resection of the femoral head and suturing of the peritoneum though laparotomy. Complete closure of the peritoneal laceration and rapid totally diverting colostomy would be recommendable in order to avoid infectious complications in such a severe central fracture-dislocation of the hip.
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Affiliation(s)
- K Ido
- Department of Orthopaedic Surgery, Japanese Red Cross Society Wakayama Medical Center and Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki-city, Okayama 710-8602, Japan
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14
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Posterior dislocation of the hip with concomitant ipsilateral fractures of both the femoral head and shaft: A case report. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2001. [DOI: 10.1007/bf01682494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Dislocation of the hip occurs only with high-energy trauma, and concomitant injuries are common. Early diagnosis and institution of treatment are necessary to obtain the best possible results. Treatment protocols include emergent reduction of the femoral head to reestablish perfusion, postreduction radiography and computed tomography to look for associated fractures and to judge the concentricity of the reduction, stability testing, and early mobilization. Open reduction may be required if a concentric reduction cannot be obtained in a closed manner. Despite appropriate management, posttraumatic arthritis and avascular necrosis may occur, with reported rates as high as 15% to 30%. Patients who sustain a hip dislocation should be made aware of these potential complications at the time of initial treatment.
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16
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Hughes MJ, D'Agostino J. Posterior hip dislocation in a five-year-old boy: a case report, review of the literature, and current recommendations. J Emerg Med 1996; 14:585-90. [PMID: 8933320 DOI: 10.1016/s0736-4679(96)00131-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Traumatic hip dislocation constitutes a true orthopedic emergency, is a relatively rare occurrence in the pediatric population, and may be accompanied by minimal trauma. Long-term morbidity such as avascular necrosis or osteoarthritis of the femoral head may be significant if the diagnosis is not expeditiously confirmed radiographically and prompt reduction employed. A poorer prognosis is conferred by duration of dislocation for longer than 6 h, advanced skeletal maturity of the patient, severe joint injury, or multiple trauma in the affected patient. A case report involving traumatic hip dislocation in a 5-yr-old boy is described followed by a comparative review of the pediatric and adult literature with current recommendations.
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Affiliation(s)
- M J Hughes
- Joint MSU affiliated Lansing Emergency Medicine Residency, East Lansing, Michigan, USA
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