The treatment of posterior hip dislocation combined with femoral fractures / 中华创伤骨科杂志

ABSTRACT

Objective To discuss the treatment method and prognosis of posterior hip dislocation combined with femoral fractures. Methods Twenty nine patients who had been diagnosed as cases of posterior hip dislocation combined with femoral head fracture were reviewed, with their type of fracture, timing of treatment and method of treatment analyzed. Twenty seven (93.1%) of the 29 cases were followed up from 1987 to 2002 for an average period of seven years. Their prognosis was evaluated according to the x ray radiography and the function of hip joints. Results According to Pipkin IV classification, 13 cases were Pipkin Ⅰ(44.8%), 9 cases Pipkin Ⅱ(31%), 3 cases Pipkin Ⅲ(10%), and 4 cases Pipkin Ⅳ(14.2%). In type I, 9 cases were rated as excellent (33.3%), 2 good (7.4%), 1 fair (3.7%) and 0 poor (0%) by Harris hip score. In typeⅡ, 0 case was rated as excellent (0%), 2 cases good (7.4%), 4 fair (14.9%) and 2 poor (7.4%). In type Ⅲ, 1 case was rated as excellent, 0 good (0%), 1 fair (3.7%) and 1 poor (3.7%). In type Ⅳ, 0 case was rated as excellent (0%), 2 good (7.4%), 1 fair (3.7%) and 1 poor (3.7%). In all the 29 cases, those which needed total hip arthroplasty (THA) were four (13.7%). Conclusions The choice of treatment method should be determined by the mechanism of injury and the type of fracture. The factors ensuring a satisfactory prognosis are (1) The age of the patients should be younger than 40 years. (2) Since a timely reduction can prevent the onset of avascular necrosis of femoral head, it should be finished within 12 hours after the injury, and the fixation should be done within 10 days. (3) In all types, early reduction of hip dislocation, early stabilization, anatomic reduction of the fracture should be achieved. (4) The prevention of possible complications should be taken into serious consideration.