Traumatic simultaneous bilateral hip dislocation is reported rarely, but the most of them are limited in young patients. The authors managed the elderly patients whose both hip was dislocated traumatically, simultaneously and who didn't have any other underlying disease and other associated fracture - femur, hip joint and pelvis, with a review of the relevant literature.
Traumatic posterior hip dislocation should be reduced emergently, but diagnosis could be delayed in a patient with head trauma or in developing countries. We have experienced neglected posterior hip dislocation for three months in a crutch-walking patient who had ipsilateral tibia fracture and alert mentality. Open reduction followed by six-weeks skeletal traction was performed. At one year follow-up, the reduced hip showed good range of motion with no evidence of avascular necrosis.
Femoral head fracture associated with posterior dislocation of the hip had been considered a rare industrial injury. However, with advances in high-speed travel its incidence increased. Previously, intertrochanteric fractures associated with posterior dislocation of hip had not been reported. Here, we report on cases of intertrochanteric fracture associated with posterior dislocation of the hip.
PURPOSE In the femoral head fracture associated with posterior dislocation of hip, we analyzed the clinical results according to the fracture types and treatment methods to promoting the guide of treatment. MATERIALS AND METHODS We used 20 cases of fractured femoral head with posterior dislocation of hip from January 1990 to December 1997, and analyzed the treatment methods and clinical results according to the Pipkin classification. RESULTS Among the 20 cases, male was 19 cases(95%), motor vehicle accident contributed 15 cases(75%), and the case of type II and IV of Pipkin classification were 7(35%) and 9(45%) cases. Closed reduction performed within 12 hours after injury with good results was conducted in 9 cases(60%) among the 15 cases. According to the treatment methods after closed reduction, good result was showed only 3 of 8 cases(37.5%) in the conservative treatment, whereas 8 of 12 cases(66.7%) in the operative treatment. According to the type of Pipkin classification, good result was showed 3 of 6 cases(50%) in conservative treatment and all of 3 cases in operative treatment among the 9 cases of type I and II, whereas none of 2 cases in conservative treatment and 5 of 9 cases(56%) in operative treatment among the 11 cases of type III and IV. The following complications were encounted; 2 cases of avascular necrosis, 1 case of traumatic arthritis, 1 case of peroneal nerve palsy and 1 case of nonunion CONCLUSION: Good results were obtained in patients with early, stable, and accurate reduction. The Computed Tomogram was helpful to find the small fragment and check the accurate reduction. Open method that restoration joint congruity seemed to be the better procedure than closed method.
We analyzed Twenty eight cases of femoral head fracture associated with posterior hip dislocation managed in Kyungpoek National University Hospital between 1984 march and 1993 June. Classification was made by Pipkin and we added impaction fracture as another classification by post reduction CT finding.
The results were as follows 1. Most common type of fracture was impaction of femoral head by CT, Which is not included by pipkin classification.
2. Excellent, or Good result according to Epstein criteria, 7 of 8 cases in Pipkin type I, 1 of 3 cases in type II ,0 off 4 cases in type III , 1 off 4 cases in type IV, 6 off 9 cases in impaction racture.
3. There were no significant difference between the results of operative treatment and conservative treatment.
4. Post reduction CT was useful to determine the method of the further treatment.
5. Complications were avascular necrosis in 5 cases, posttrumatic arthritis in 3 cases, sciatic nerve paresis in 2 cases, heterotropic ossification in 1 case.