As an unusual traumatic presentation, acetabular fracture and concomitant ipsilateral intertrochanteric femur fracture: a retrospective case series of 18 patients

The floating hip injury: a descriptive study and case-control analysis

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.

Ipsilateral femoral neck, intertrochanteric and acetabular fractures with posterior dislocation of the hip: A case report and literature review

INTRODUCTION

Traumatic hip dislocation with ipsilateral femoral neck fracture, intertrochanteric fracture and acetabular fracture is a rare and serious injury that occurs mostly in young patients and after high-energy trauma. The treatment of these injuries is a major challenge for orthopedic surgeons; it can have devastating consequences if not treated properly, including avascular necrosis of the femoral head and traumatic osteoarthritis of the hip. In previous case reports only internal fixation of femoral neck fracture was performed without revascularisation and there was a lack of long-term follow-up results. In this report, we fixed the fracture revascularised the patient, and obtained good prognostic results at up to 20 months of follow-up.

CASE PRESENTATION

Here, we report an 18-year-old patient with systemic polytrauma resulting from a car accident. The trauma included ipsilateral posterior hip dislocation, acetabular fracture, femoral intertrochanteric fracture, and femoral neck fracture. In addition, the patient also had an ipsilateral open tibiofibula fracture. We chose the surgical treatment of a proximal femoral locking compression plate (PFLCP), femoral quadratus bone flap graft, and cannulated compression screw to treat the proximal femoral fracture. The patient was followed up for nearly 20 months; the range of motion of his hip was close to normal, and his hip function was good.

DISCUSSION AND CONCLUSIONS

Traumatic hip dislocation with ipsilateral femoral neck fracture, intertrochanteric fracture and acetabular fracture is a rare and serious injury, and surgical intervention is often needed. Because of the high risk of femoral head necrosis in such complex injuries, it is very important to protect/restore the blood supply of the femoral head during surgery. Therefore, in younger patients, we believe that the use of a quadratus femoris bone flap graft and PFLCP is an acceptable treatment for this severe injury. We discuss the management of this rare case and review the current literature to provide the best evidence-based recommendations for this injury pattern. We conclude that for patients with complex ipsilateral proximal femoral and acetabular fractures combined with hip dislocation, the key to surgical treatment, in addition to anatomic reduction and good fixation, is the primary reconstruction of the femoral head blood supply.

Outcome of acetabulum fractures treated with open reduction and internal fixation through Kocher-Langenbeck Approach: A retrospective study

BACKGROUND

Complex anatomy of acetabular fracture is quite challenging for the orthopedic surgeons. Many Acetabular fracture fixation approaches have been used for a long time to treat different fracture patterns of acetabulum. Kocher-Langenbeck Approach (K-L approach) of acetabulum fracture is usually used by most of orthopedic surgeons. In this retrospective study, we evaluated the clinical and functional outcome of subtypes of acetabulum fractures treated with K-L approach. Assessment of Intra and postoperative complications of subtypes of acetabulum fractures was also done.

METHOD

Eighty patients (48 men and 32 women) were included in this retrospective study with a mean follow-up period of 2.6 years. Fractures were classified according to Letournal and Judet classification. K-L approach was performed in all these patients. Post operative reduction, Radiological outcome was quantified using Matta's criteria while the functional outcome was assessed according to Merle d'Aubigné and Postel scoring system. Postoperative complications were evaluated.

RESULTS

The mean age of a total of 80 cases was 43.64 ± 13.24 year. The type of fracture was found to be significantly associated with concentric/non-concentric reduction (p = 0.003) and with post op reduction (p = 0.005). The post operative reduction was found to be significantly associated with radiological (p < 0.001) and functional outcome (p < 0.001) at one year post op. The type of fracture was found to be significantly associated with radiological outcome (p < 0.001) while non-significantly found to be associated with functional outcome at 1 year (p = 0.050). The type of fracture was found to be significantly associated with post op complications (p = 0.003) and with arthritis (p = 0.001).

CONCLUSION

K-L approach is a multifaceted and convenient approach for treating acetabulum fractures. Type of fracture and post-operative reduction are key factors for a satisfactory outcome. Transverse with posterior wall fracture has the worst prognosis.