A Prospective Evaluation of the Management and Outcome of Traumatic Posterior Dislocation of the Hip-A Preliminary Report

Abstract

Traumatic posterior dislocation of the hip (TPDH) is considered an absolute orthopeadic emergency and the outcome of management and prognosis is time dependent. The optimum time within which reduction should be achieved to yield excellent result has remained an issue of considerable controversy. In this paper we evaluated the influence of interval between injury and reduction of dislocation on the choice and outcome of management of TPDH. This is a five year prospective and multicenter study in North-central Nigeria. Patients with TPDH, who were treated and had a minimum follow up of 24 months, were included in this study. Reduction was achieved under general anaesthsia. Outcome of treatment was evaluated using the clinical criteria proposed by Matta. Forty-seven patients were evaluated comprising 36 (76.6%) males and 11 (23.4%) females. The commonest cause of injury was road traffic accident in 40 (85.1%). Presentation was considered as early if patient presented within 6 hours of injury and late if later than this. Using Thompson and Epstein's (TE) classification of posterior dislocation of the and Pipkin's (P) sub-classification of type 5, there were 10TE1; 25TE2; 9TE3; 2TE4 and 1 TE5P2. TE1 and TE2 make up 74.5% of cases. 32 (68.1%) presented early and 15 (31.9%) late. Thirty nine patients had successful closed reduction comprising 32 that presented early and seven late. The mean interval between injury and reduction was 9.7 (+/- 1.2) hours. Two (4.3%) patients were reduced within 6 hours, 32 (68.1%) were reduced within 7-12 hours. Five patients had open reduction and three had salvage Girdlestone pseudo-arthroplasty. Outcome assessment showed in the closed reduction group, 22 (59.5%) had excellent score, and 11 (29.7%) had good. These patients were all reduced within 12 hours. Two each had fair and poor outcome while two were lost to follow up. Seventeen (36.2%) developed complications comprising 12 (70.6%) who presented late and five (29.4%) who came in early. The commonest complication was avascular necrosis of the femoral head in eight (47.1%), all presented late with intractable pain; eight (47.1%) with pain of unknown origin and one (5.8%) with sciatic nerve injury which resolved on conservative management. Reduction of PDH within 12 hours is associated with excellent results and few minor complications.