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

Abstract

BackgroundThe 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.MethodsThirteen 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 length discrepancy were evaluated.ResultsAll 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.ConclusionEffective 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.

Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries

“…When the diagnosis of a hip dislocation is delayed for more than 72 h, the condition is defined as "neglected." A Chinese study observed an average leg length discrepancy of 7.7 cm in 13 patients with neglected hip dislocation; therefore, a staged surgical protocol with an external fixation-assisted prereduction was performed [30]. The literature about both delayed and neglected THDs is scarce and mostly originates from the 1950s to the 1980s [31,32] or from low-income countries [31,33,34].…”

Staged reconstruction of unilateral neglected hip dislocation through total hip arthroplasty and subsequent intramedullary femoral lengthening

“…Traumatic as well as septic hip dislocations may, if detected timely, be treated by closed or surgical reduction, even though the rate of avascular necrosis of the femoral head is tremendously high [2][3][4]. However, if the dislocation has been present for a longer period of time, reduction is often not feasible due to soft tissue contractures and potential nerve damage if reduction is attempted [5].…”