Posterior Fracture Dislocation of the Hip with Fractures of the Femoral Head

Abstract

In general, all traumatic dislocations of the hip must be treated as surgical emergencies. Multiple attempts at closed reduction are contraindicated, particularly in Type V dislocations. Every effort must be made to recognize the dislocation, particularly in patients with other severe lower extremity trauma. Reduction within 24 hours gives better results than late reductions. Roentgenograms of the pelvis must include both hips after closed or open procedures as a check for a concentric reduction of the hip. Any abnormality, or failure to reduce the avulsed head fragment, demands an immediate hip arthrotomy. The good results, after primary open reduction, although under 508, were better than closed or closed followed by open reduction. Our approach is to discard the avulsed head fragment. No conclusions can be made regarding screw fixation of the avulsed fragment because there was an insufficient follow-up period in this procedure. Longterm follow-up examination is necessary in Type V fracture dislocations because one can anticipate that

Femoral head fractures

“…In our patients, the average age was lower than the patients treated by Weigand et al [24] and Hougaard et al [10], but similar to those of Epstein et al [4].…”

“…Two-thirds of all traumatic dislocations occur in adolescence or early adult life, usually too young an age for total hip arthroplasty, if complications develop [4]. In our patients, the average age was lower than the patients treated by Weigand et al [24] and Hougaard et al [10], but similar to those of Epstein et al [4].…”

“…Type V dislocations, which include femoral head fractures, have a low percentage of successful results [4], regardless of treatment. The majority of these injuries are results of automobile accidents and mandatory use of seat belts is the main priority in prevention of these injuries.…”

“…A surgical procedure that embarrasses whatever blood supply remains is therefore inadvisable [22]. Six patients in a series of Epstein et al [4] were treated by anterior exposure for posterior dislocation, avascular necrosis developed in five patients. In our patients, reduction of dislocation by closed means was achieved easily, shortly after the injury, so, lateral approach was satisfactory after this to give direct access to the acetabulum and facilitates visualization of the fracture fragments to get proper reduction.…”

Fractures of the femoral head: what are the reasons for poor outcome?

“…3). The average age at the time of injury was 28 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) years. Most of the fractures were due to traffic accident; only one patient sustained injury from a motor vehicle accident.…”