Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture

Milenković, Saša; Mitković, Milan; Mitković, Milorad

doi:10.1007/s00068-020-01495-x

Cited by 24 publications

(16 citation statements)

References 31 publications

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“…The correlation between the time to femoral head reduction, which is known to influence functional outcomes, and the Pipkin classification was not statistically significant in the current study; however, a significant correlation was found between functional outcomes and age, associated acetabular fracture, AVN development, and radiologic results [ 4 , 30 ]. This may be because older age is associated with more difficult postoperative rehabilitation, consequently, a longer time to return to daily activities.…”

Section: Discussionmentioning

confidence: 64%

“…Traumatic hip dislocation accompanied by femoral head fracture is frequently associated with damage to other organs and combined fractures and may cause complications, such as avascular necrosis (AVN) of the femoral head, traumatic arthritis, and heterotopic ossification (HO) [ 2 , 3 ]. Therefore, prompt and accurate treatment in the early stage of the injury and continuous follow-up are required [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Safety of surgical hip dislocation in femoral head fracture and dislocation (FHFD) and avascular necrosis risk factor analysis of FHFD: midterm results confirmed by SPECT/CT and MRI

Yoon

Kim

et al. 2022

J Orthop Surg Res

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Background The study aim was to report the treatment outcomes of trochanteric flip osteotomy (TFO) with surgical hip dislocation (SHD) for femoral head fracture and dislocation (FHFD) and to investigate the risk factors for avascular necrosis (AVN) of the femoral head. Methods The data of 34 patients (29 men, 5 women; mean age 37.9 years) diagnosed with FHFD and treated with TFO with SHD between May 2009 and February 2018 with an average follow-up period of 5.1 years (range 2.8–10.5 years) were analyzed. Clinical outcomes were evaluated using the Merle d'Aubigné–Postel score and Thompson–Epstein Scale. Radiologic outcomes were classified according to the Matta classification. AVN was confirmed using magnetic resonance imaging or single-photon emission computed tomography/computed tomography. The occurrence of complications was examined, and factors influencing complications, AVN. Results Regarding the Pipkin’s classification, there were 7 patients with type II, 2 patients with type III, and 25 patients with type IV fractures. Posterior wall fractures accompanied all associated acetabular fractures in the patients with Pipkin type IV fractures. Radiologically, the union of acetabular and femoral head fractures was observed within 6.1 months on average (range 4–10 months) in 32 patients, except two patients who developed femoral head AVN. Clinically, the average Merle d'Aubigné–Postel score was 14.4 points (range 8–17 points), and 22 patients had good or excellent results on the Thompson–Epstein Scale. Two patients developed femoral head AVN with both having displaced femoral neck fractures associated with FHFD. AVN was significantly correlated with femoral neck fractures (P = 0.000). Conclusion TFO with SHD is a safe and useful approach for the treatment of FHFD. Particular attention should be paid when treating femoral head fractures associated with displaced femoral neck fractures because of the high risk of AVN development.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Safety of surgical hip dislocation in femoral head fracture and dislocation (FHFD) and avascular necrosis risk factor analysis of FHFD: midterm results confirmed by SPECT/CT and MRI

Yoon

Kim

et al. 2022

J Orthop Surg Res

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“…According to Pavelka et al , 11.7% of patients developed of the femoral head osteonecrosis [35]. The fact is that the femoral head osteonecrosisis much more common in acetabular fractures that are associated with posterior hip dislocation [36].…”

Section: Femoral Head Osteonecrosismentioning

confidence: 99%

Fractures of the acetabulum - surgical treatment and complications

2020

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Acetabular fractures represent severe injuries that mostly occur in car accidents, or after falling from greater heights, most often in the working male population. Acetabular fractures are present in our clinical practice and require a good education and surgical training. Surgical experience is one of the prerequisites for achieving good treatment results, because these fractures are accompanied by numerous complications. In order to acquire knowledge and skills in this field of surgery, it is necessary to have a national center for education at one of the Medical Faculties in Serbia. All dislocated acetabular fractures (? 2mm), require early surgery, anatomical reduction and stable internal fixation of acetabular fracture. Acetabular fracture-dislocation requires urgent reduction of the dislocated femoral head. The anatomic reduction of the fracture is related to the time of definitive bone fixation of the fracture. After 14 days from the fracture, anatomic reduction is more difficult to achieve. In addition to these factors that positively affect the final results of treatment, there are negative factors as well, that result in poor outcomes. They are directly correlated to the initial trauma that occurs at the time of injury. Fracture comminution, large dislocation (> 20mm), injury of the femoral head, posterior dislocation of the hip, impaction, traumatic or iatrogenic sciatic nerve palsy, are factors that negatively affect the results and are responsible for complications, as opposed to positive factors.

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“…Pape et al evaluated multiply injured patients with THDs in the 1990s and observed the development of avascular necrosis even in "simple" dislocations [5]. Various long-term sequelae have been characterized in the literature, including post-traumatic osteoarthritis of the hip, avascular necrosis of the femoral head, periarticular ossifications, recurrent dislocation, and ischial nerve palsy [6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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

Weber

Lefering

Sellei

et al. 2022

JCM

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Introduction: Traumatic hip dislocations (THDs) are severe injuries associated with considerable morbidity. Delayed recognition of fracture dislocations and neurovascular deficits have been proposed to cause deleterious long-term clinical outcomes. Therefore, in this study, we aimed to identify characteristics of epidemiology, injury mechanisms, and associated injuries to identify patients at risk. Methods: For this study based on the TraumaRegister DGU® (January 2002–December 2017), the inclusion criterion was an Injury Severity Score (ISS) ≥9 points. Exclusion criteria were an isolated head injury and early transfer to another hospital. The THD group was compared to a control group without hip dislocation. The ISS and New ISS were used for injury severity and the Abbreviated Injury Scale for associated injuries classification. Univariate and logistic regression analyses were performed. Results: The final study cohort comprised n = 170,934 major trauma patients. We identified 1359 individuals (0.8%) with THD; 12 patients had sustained bilateral hip dislocations. Patients with THD were predominantly male (79.5%, mean age 43 years, mean ISS 22.4 points). Aortic injuries (2.1% vs. 0.9%, p ≤ 0.001) were observed more frequently in the THD group. Among the predictors for THDs were specific injury mechanisms, including motor vehicle accidents (odds ratio (OR) 2.98, 95% confidence interval (CI) 2.57–3.45, p ≤ 0.001), motorcycle accidents (OR 1.99, 95% CI 1.66–2.39, p ≤ 0.001), and suicide attempts (OR 1.36, 95% CI 1.06–1.75, p = 0.016). Despite a lower rate of head injuries and a comparable level of care measured by trauma center admission, both intensive care unit and total hospital stay were prolonged in patients with THD. Conclusions: Since early diagnosis, as well as timely and sufficient treatment, of THDs are of high relevance for long-term outcomes of severely injured individuals, knowledge of patients at risk for this injury pattern is of utmost importance. THDs are frequently related to high-energy mechanisms and associated with severe concomitant injuries in major trauma patients.

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Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture

Cited by 24 publications

References 31 publications

Safety of surgical hip dislocation in femoral head fracture and dislocation (FHFD) and avascular necrosis risk factor analysis of FHFD: midterm results confirmed by SPECT/CT and MRI

Safety of surgical hip dislocation in femoral head fracture and dislocation (FHFD) and avascular necrosis risk factor analysis of FHFD: midterm results confirmed by SPECT/CT and MRI

Fractures of the acetabulum - surgical treatment and complications

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

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