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

Abstract

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.

Traumatic Native Hip Dislocations: An Audit at a Major Trauma Centre and Assessment of Clinical Practice at Centres Across the United Kingdom

“…Native hip dislocations are rare injuries involving high-energy trauma and are clinical emergencies where outcomes are associated with timely reduction. Currently, the leading cause of these injuries is MVAs, accounting for up to 95% events [ 4 , 7 , 8 ]. This study involved posterior dislocations, which account for 90% of native hip dislocations [ 9 ].…”

“…This stability is due to the osseous anatomy and the surrounding ligamentous structures and musculature [ 2 ]. Thus, hip dislocations are rare events with up to 95% occurring in motor vehicle accidents (MVAs) [ 3 , 4 ].…”

The Movement of a Musical Work. Ernst Krenek's Opus 20 in the Interwar Years

“…This also affected composers returning to Germany after 1945. 548 op. 20 in Boston was somewhere in between, we might say.…”

Intermediate to Long-Term Results Following Traumatic Hip Dislocation

“…Traumatic hip dislocations are orthopaedic emergencies 1 that are typically sustained as the result of high-energy mechanisms such as traffic accidents, falls from a height, or participation in high-impact sports 2-4 and are commonly associated with other organ and bone injuries 5-8 . The most common direction of dislocation is posterior (in up to 90% of cases), with such injuries being caused by a large force directed against the flexed knee, with the hip flexed, adducted, and internally rotated 9 .…”