External fixation-assisted reduction for the treatment of neglected hip dislocations with limb length discrepancy: a retrospective study of 13 cases.

Abstract

Background: The purpose of this study was to evaluate a new method for treating neglected hip dislocation with limb length discrepancy by using external fixation-assisted pre-reduction. Methods: Thirteen patients admitted between January 2010 to February 2018 with a mean duration from injury to surgery of 5.0±2.1 months and an average preoperative leg-length discrepancy of 7.7±2.3 cm were enrolled in this study. The dislocation and associated acetabular fracture type, clinical outcomes and residual limb equality were evaluated. Results: All patients had posterior dislocations, and nine patients presented with acetabular fractures and were followed-up for at least 12 months. The average traction duration of external fixators was 28.8±8.0 days and all patients received second-stage open reduction and internal fixation. Six patients showed residual limb length discrepancy within 2 cm. Patients showed significant improvement in hip function and pain relief. Complications including avascular femoral head necrosis and osteoarthritis occurred in three patients. Conclusion: Effective correction of limb length discrepancy and improved function were observed in patients with neglected hip dislocations and limb equality using traction by external fixation combined with second-stage open reduction. Further follow-up is required to determine long-term outcomes. Keywords: neglected hip dislocation, limb length discrepancy, external fixatio

Neglected Posterior Hip Dislocation in Adults presenting after One Year Managed Successfully with Single Stage Total Hip Arthroplasty: A Case Series

“…Pai achieved closed reduction by traction in 2 out of 6 adult patients who were of a duration < 3 months [ 4 ]. Other authors have failed to achieve closed reduction and have had to resort to open reduction with good to excellent results in 37 of 39 cases which were mostly children [ 2 , 3 , 7 , 10 , 11 ]. Fibrous tissue develops in the acetabulum after 3 months of delay which makes close reduction impossible or causes a non-concentric reduction thus needing open reduction [ 12 ].…”

“…Fibrous tissue develops in the acetabulum after 3 months of delay which makes close reduction impossible or causes a non-concentric reduction thus needing open reduction [ 12 ]. Li et al achieved good to excellent results in only 7 adult patients out of the 13 patients treated with traction and open reduction with a mean duration from injury to treatment being 5 months [ 7 ]. In our study, two cases were more than 1-year old and one case was more than 2-years-old Type 1 dislocations.…”

“…Attempts of closed reduction have failed in adults when the duration of neglect has been more than 3 months as fibrous tissue is present in the acetabulum [ 4 ]. Li et al have mentioned the results of open reduction in neglected hip dislocations in 13 patients with a mean duration from injury to the intervention being 5 months, only 7 of 13 patients reported favorable outcomes and only 5 patients were pain free [ 7 ].…”