The Cause of Primary Reduction Failure in Hip Dislocation with or without Hip Fracture

PURPOSE: A rapid and accurate reduction is important for hip dislocated patients to avoid various potential complications, including avascular necrosis of the femoral head. We analyzed hip dislocation cases, ones that particularly failed during the primary reduction trial. MATERIALS AND METHODS: Eighty-seven patients with hip dislocation, who visited the emergency department between January 2007 and September 2015, were retrospectively analyzed. Of them, 68 patients were successfully treated in the first closed reduction trial, and the remaining 19 patients were unsuccessful. Of the 19 unsuccessful first trial, 12 patients were successfully treated in the second closed reduction; however, in the remaining 7 patients, open reduction was performed in the operation room with general anesthesia. Every closed reduction was practiced by at least 2 orthopedic doctors, and open reduction was performed by a single senior author. RESULTS: The rate of first reduction failure was higher, with statistical significance, in patients aged under 50 years, male gender, and those with combined around hip fractures, including femoral head and acetabular fracture (p0.05). CONCLUSION: To evaluate the patients with hip dislocation, realizing the type of dislocation, presence of accompanied fracture, location and size of fracture fragment, age, as well as gender of patients is important. If the fracture fragment is impacted in the hip joint and the size of the fragment is large, then the operative treatment is considered, rather than the repetitive trial of closed reduction by constraint.

The Cause of Primary Reduction Failure in Hip Dislocation with or without Hip Fracture

PURPOSE: A rapid and accurate reduction is important for hip dislocated patients to avoid various potential complications, including avascular necrosis of the femoral head. We analyzed hip dislocation cases, ones that particularly failed during the primary reduction trial. MATERIALS AND METHODS: Eighty-seven patients with hip dislocation, who visited the emergency department between January 2007 and September 2015, were retrospectively analyzed. Of them, 68 patients were successfully treated in the first closed reduction trial, and the remaining 19 patients were unsuccessful. Of the 19 unsuccessful first trial, 12 patients were successfully treated in the second closed reduction; however, in the remaining 7 patients, open reduction was performed in the operation room with general anesthesia. Every closed reduction was practiced by at least 2 orthopedic doctors, and open reduction was performed by a single senior author. RESULTS: The rate of first reduction failure was higher, with statistical significance, in patients aged under 50 years, male gender, and those with combined around hip fractures, including femoral head and acetabular fracture (p0.05). CONCLUSION: To evaluate the patients with hip dislocation, realizing the type of dislocation, presence of accompanied fracture, location and size of fracture fragment, age, as well as gender of patients is important. If the fracture fragment is impacted in the hip joint and the size of the fragment is large, then the operative treatment is considered, rather than the repetitive trial of closed reduction by constraint.

Risk Factors for the Failure of Non-operative Reduction of Intussusceptions / 대한소아소화기영양학회지

PURPOSE: Intussusceptions are one of the most common causes of intestinal obstruction in infants and young children. Although it is easily treated by non-operative reduction using barium, water or air, this treatment is very stressful for young patients and may cause bowel perforation, peritonitis and shock. In this study, we identified the risk factors associated with the failure of non-operative reduction, to identify a group of children that would benefit from the procedure and those who would not. METHODS: We reviewed the medical records of patients with intussusception who were treated at the Korea University Medical Center Ansan hospital from March 1998 to July 2006. Three hundred fourteen children with intussusception were identified. Among them, non-operative reductions were performed in three hundred. Clinical and radiological variables were compared according to the failure or success of the non-operative reduction. RESULTS: Non-operative reductions were successful in 243 (81%) and failed in 57 (19%). The group that had failed procedures had a younger age (12.3+/-17.2 months vs. 18.0+/-15.8 months, p=0.03), longer symptom duration before reduction (33.6+/-29.0 hr vs. 21.5+/-20.3 hr, p<0.01), more vomiting and lethargy (p<0.01), but less abdominal pain and irritability (p<0.01), compared with the group that had a successful procedure. Logistic regression analysis showed that the factors associated with the failure of non-operative reductions were a younger age, less than 6 months of age (odds ratio: 2.5, 95% confidence interval: 1.2~5.2, p=0.01), duration of symptoms, longer than 24 hrs before reduction (odds ratio: 2.1, 95% confidence interval: 1.2~4.2, p=0.03), bloody stool (odds ratio: 4.8, 95% confidence interval: 1.9~12.2, p<0.01), lethargy (odds ratio: 3.4, 95% confidence interval: 1.1~10.4, p=0.04), and abdominal pain or irritability (odds ratio: 0.2, 95% confidence interval: 0.1~0.4, p<0.01). CONCLUSION: For children with intussusception, an age younger than 6 months, and duration of symptoms more than 24 hrs before reduction, as well as the presence of bloody stools, lethargy and abdominal pain or irritability were variables associated with failure of a non-operative reduction. Knowledge of these variables should be considered in making clinical decisions for therapeutic interventions.

A Comparison of Air Reduction and Operation in Childhood Intussusception

PURPOSE: Intussusception is one of the most common cause of childhood intestinal obstructions. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. METHODS: In order to evaluate the factors contributing to air-reduction failure, we reviewed cases of childhood intussusception admitted via the ER and managed by air enema reduction from 1994 to 1998. They were divided into two groups and compared retrospectively by using medical records. Group I was the operation group after air-reduction failure, and group II was the air-reduction group. RESULTS: In 319 cases (279 patients), group I consisted of 112 cases (110 patients), and group II consisted of 207 cases (169 patients). No differences in age, sex, body weight, location of intussusception, laboratory findings (leukocytosis and thrombocytosis), presence of bloody stool, and body temperature were noted between the two groups. Factors significantly contributing to air-reduction failure were duration of symptoms, type of intussusception and a few physical findings (abdominal distension, palpable mass, lethargy, and vomiting). The recurrence rate of group I was significantly lower than that of group II, and most recurrences developed in the first postoperative month. CONCLUSION: Childhood intussusceptions of a non-ileocolic type with longer durations of symptoms and severe clinical findings have a higher chance of air-reduction failure.