Avascular necrosis of the femoral head in the patients with posterior wall acetabular fractures associated with dislocations of the hip

Abstract

Acetabular fractures are severe injuries, mostly occured in young patients after traffic accident or fall from heights. Of the all acetabular fractures, posterior wall acetabular fractures are the most often observed. Regarding to mechanism of the injury, about 30% of these fractures are associated with posterior hip dislocation. The incidence of AVN in 18 patients with posterior wall acetabular fractures associated with dislocations of the hip is presented. Thompson-Epstein Scale (type I-V) was used as the classification of the injury. Kocher-Langenbeck surgical approach was achieved in all patients. Average following time after surgery was 22, 66 months (8-36 months). After that period the incidence of femoral head AVN was observed in 33.3%. Femoral head AVN was observed in 5.55% of patient who was treated by the reduction of hip dislocation in first 24 hours after injury, while in patients with later reduction, femoral head AVN were observed in 27.77%. Posterior wall acetabular fractures associated with hip dislocation are severe injuries. Urgent, closed reduction of the hip, early definitive stable osteosynthesis of acetabulum and the experience of surgical team are factors that greatly decrease the possibility for AVN occurence. Later reduction, comminution of posterior wall of the acetabulum (Thompson- Epstein III et IV), impaction, chondral lesion of the femoral head and associated fractures of femoral head, increase the possibility for AVN occurence.