Hip dislocations and femoral head fractures

Abstract

Traumatic dislocation of the hip joint is a rare injury with significant long-term implications for patients. The most common mechanism is a dashboard injury, when the knee impacts the dashboard with force during a high speed road traffic accident. Hip dislocation is a surgical emergency, and early reduction of the hip reduces long-term complications such as avascular necrosis (AVN) and osteoarthritis. Once reduced CT scanning is use to determine the size of the fragment, assess reduction and identify any foreign bodies in the joint. Injuries can then be classified according to the size and location of the fractured fragments. The aim of definitive management is anatomical reconstruction of the femoral head, and reduction of the joint and weight bearing surface. Good outcome can be achieved in patients who have early, stable reduction of the hip. Congruent reduction and fixation of large articular fragments, or removal of small comminuted intraarticular fragments reduces the occurrence of late complications affecting function and quality of life, such as AVN or post-traumatic arthritis. Long-term follow-up is required to identify patients who may need further intervention or revision to total hip arthroplasty in the years following injury.