Traumatic Posterior Hip Dislocation Research Articles

CT Findings of Traumatic Posterior Hip Dislocation after Reduction

Purpose: To evaluate the CT images of reduced hips after posterior hip dislocation and to propose specific diagnostic criteria based on the CT results. Materials and Methods: We retrospectively reviewed the CT findings on 18 reduced hips from 17 patients with radiographs and clinical histories of traumatic posterior hip dislocations by evaluating 18 corresponding CT scans for joint space asymmetry, intraarticular abnormalities (intra-articular fat obliteration, loose bodies, and joint effusion), changes in posterior soft tissue (capsule, muscles, and adjacent fat), the presence, and location of fractures (acetabulum and femoral head). Results: All 18 hips (100%) showed posterior soft tissue changes. In total, 17 hips (94.4%) had intra-articular abnormalities and 15 hips (83.3%) had joint space asymmetries. In addition, 17 hips (94.4%) had fractures involving the acetabula (15 cases, 88.2%), the femoral head (13 cases, 76.5%), or on both sides (11 cases, 64.7%). The most frequent fracture location was in the posterior wall (13/15, 86.7%) of the acetabulum and in the anterior aspect (10/13, 76.9%) of the femoral head. Conclusion: Patients with a prior history of posterior hip dislocation showed specific CT findings after reduction, suggesting the possibility of previous posterior hip dislocations in patients.

Unusual Combination of Femoral Head Dislocation Associated Acetabular Fracture With Ipsilateral Neck and Shaft Fractures: A Case Report

Traumatic posterior hip dislocation associated with a fracture of the femoral neck is a rare injury. The combination of an acetabular fracture and a fracture of the femoral neck and shaft with posterior dislocation of the femoral head is even more rare. No case similar to ours was found in the literature available. We report a case of ipsilateral femoral neck and shaft fracture with associated fracture of acetabulum and dislocation of femoral head in addition to the diastasis of symphysis pubis and fracture of the right side radius distal end fracture in a car driver. The case was an unusual femur and hip injury that could not be classified with the present classification systems.

Treatment of Neglected Traumatic Posterior Hip Dislocation in Children

Treatment of Neglected Traumatic Posterior Hip Dislocation in Children

Neglected Traumatic Hip Dislocation in Children

Traumatic dislocation of the hip in children is a rare injury. We report the outcome of open reduction of neglected traumatic posterior hip dislocation in 18 children. All patients had posterior dislocation and no associated fracture. They presented to the hospital because of persisting pain, deformity, and limp that were present for a mean period of 16 weeks after injury (range, 6-52 weeks). Open reduction was done in all patients because none of the hips could be reduced by skeletal traction in abduction. All of the hips had varying degrees of avascular necrosis (osteonecrosis), with preservation of joint space as seen on radiographs. At short term followup, seventeen children had an excellent functional outcome. We suggest that open reduction is a satisfactory treatment for neglected hip dislocation in children because an anatomically placed femoral head maintains the stimulus for growth of the pelvis and the femur. It prevents deformity and maintains limb length.

Neglected Traumatic Posterior Hip Dislocation in a Crutch-walking Patient: A Case Report

Neglected Traumatic Posterior Hip Dislocation in a Crutch-walking Patient: A Case Report

Sciatic nerve injuries associated with traumatic posterior hip dislocations.

This study was undertaken to test the hypothesis that patients transferred between hospitals with a dislocated hip have a greater incidence of sciatic nerve injury than patients who have their hip reduced at the first facility. One hundred six dislocated hips were included in this 12-year retrospective study. Sixty-nine hips were relocated at the first hospital and 36 patients were transferred with the hip still dislocated to LDS Hospital. There was a higher incidence of major sciatic nerve injury (complete sciatic or peroneal motor deficit) in patients transferred with the hip still dislocated (P =.0453). Time to relocation was significantly longer in patients with major motor nerve injury (P =.016). The presence of an associated fracture had no influence on sciatic nerve injury rates. The length of time a hip remains dislocated influences the incidence and severity of major sciatic nerve injury.

Unusual presentation of sciatica in a 14-year-old girl

The sciatic nerve can be compressed by a variety of causes, while intervertebral disc herniation is the most common cause of sciatica [Surg. Neurol. 46 (1996) 14], other documented causes include, infection, neoplasm, degenerative disease of a spine, congenital anomalies and traumatic posterior hip dislocation [BMJ 287 (1983) 157]. Sciatic neuropathy in children is uncommon. We present an unusual case of sciatic nerve compression in a 14-year-old-girl that was caused by an avulsion fracture of the ischial tuberosity. The compression was relieved by surgical excision of the avulsed ischial tuberosity.

外傷性股関節後方脱臼の治療成績

The clinical outcome of fifteen patients with traumatic posterior hip dislocations was reviewed. The mean follow-up period was 4.3 years. There were 14 males and one female, with a mean age at dislocation of 48.9 years. All radiographs were reviewed and graded based on the system devised by Thompson and Epstein in 1951, and all patients were reviewed clinically and radiographically and classified as excellent, good, fair or poor, based on the system described by Stewart and Milford (1954) and expanded by Epstein (1974). There were seven patients (46.7%) with type I, two (13.3%) with type II, four (26.7%) with type III, one (6.7%) with type IV and none with type V. Four patients (26.7%) were rated as having excellent results at the latest follow-up, six (40%) had good; one (6.7%) had fair and four (26.7%) had poor. Twelve patients (80%) had multiple injuries. The incidence of Knee injuries was especially very high (40%). Two patients (13.3%) with type I or III developed avascular necrosis in the series.

Open reduction of late unreduced traumatic posterior hip dislocation in 12 children.

We present 12 children with late unreduced traumatic posterior dislocation of the hip. All had posterior dislocation and no associated fracture. The dislocation had remained unreduced for a mean period of 20 (6-52) weeks. Open reduction was done in all cases, since none of the hips could be reduced with upper tibial skeletal traction in abduction. All the hips showed varying degrees of avascular necrosis, with preservation of joint space on roentgenograms. 11 children had an excellent outcome, according to the criteria of Garrett et al. (1979), after a follow-up of mean 26 (24-36) months. We suggest that open reduction is a satisfactory treatment for hip dislocation of any duration in children.

Posterior hip dislocations: a cadaveric angiographic study.

Avascular necrosis (AVN) of the femoral head after a traumatic posterior hip dislocation (Thompson and Epstein type I) has been hypothesized to occur due to changes in blood flow. However, to the best of our knowledge of the English literature, a human cadaveric angiographic study has never been performed to delineate these vascular changes. Six fresh frozen human cadavers were used to examine the effects of posterior hip dislocation on the extraosseous and intraosseous blood supply to the femoral head and neck. After a forceful posterior hip dislocation was performed on the cadavers, the proximal vessels were injected with a radioopaque colored latex liquid polymer (Microfil) and examined under cinefluoroscopy. The contra lateral hips were used as controls and were examined in a similar manner. Both hips of the cadavers were harvested, and a macroscopic and microscopic examination was performed. The cine-fluoroscopic examination delineated the dynamic effects of posterior dislocation on the surrounding vasculature. Filling defects were most notable at the junction of the external iliac and common femoral arteries. Filling defects were also present in the circumflex vessels. Compared to controls, the common femoral and circumflex vessel filling defects were statistically significant (p < 0.004). These defects were secondary to an apparent stretching and twisting of the artery caused by the pull and rotation of the dislocated hip. A number of collateral vessels from the gluteal arteries were also demonstrated on fluoroscopic examination. The macro and microscopic examination did not show a qualitative or a quantitative difference in the amount of latex present in the dislocated and control groups. Based on the results of this study, changes in the extraosseous blood flow to the dislocated hip do occur. The vessels that appear to be most affected by the dislocation are the common femoral and circumflex vessels. However, these extraosseous changes do not consistently result in changes in the intraosseous blood flow possibly due to collateral circulation. Relocating the femoral head in a traumatic posterior hip dislocation may provide earlier blood flow to the femoral head by relieving tension across the femoral and circumflex vessels. Delayed relocation could contribute to the development of AVN in the femoral head by not only inducing immediate ischemia at the time of injury but by also producing a progressive and delayed form of arterial damage in the femoral and circumflex vessels. AVN may not be an absolute outcome of posterior hip dislocations due to preexisting collateral circulation and/or the preservation of the femoral circumflex vessels.

Traumatic Hip Dislocation.

In brief Traumatic posterior hip dislocation is a rare but potentially disabling injury that is most often associated with severe trauma. Prompt recognition and early reduction are essential to a good outcome. An x-ray rules out fracture of the femoral head or acetabulum and should be routinely performed before reduction of the dislocation under anesthesia.

Bilateral Traumatic Posterior Hip Dislocation: CT Findings

Bilateral Traumatic Posterior Hip Dislocation: CT Findings

Posterior Hip Dislocation Associated with Acute Traumatic Injury of the Thoracic Aorta

Posterior hip dislocation associated with acute injury to the thoracic aorta is a previously unrecognized injury complex. This study reveals that 8% of patients with posterior hip dislocation have associated injury to the thoracic aorta because of abrupt deceleration injuries. This study defines the association of traumatic posterior hip dislocation and acute traumatic injury of the thoracic aorta, describes the mechanism of injury, and discusses the evaluation of a patient with a suspected acute traumatic aortic injury.

Posterior Hip Dislocation Associated with Acute Traumatic Injury of the Thoracic Aorta

Summary: Posterior hip dislocation associated with acute injury to the thoracic aorta is a previously unrecognized injury complex. This study reveals that 8% of patients with posterior hip dislocation have associated injury to the thoracic aorta because of abrupt deceleration injuries. This study defines the association of traumatic posterior hip dislocation and acute traumatic injury of the thoracic aorta, describes the mechanism of injury, and discusses the evaluation of a patient with a suspected acute traumatic aortic injury.

臼がい・骨頭骨折を合併した外傷性こ関節後方脱臼の一例

Recently we have experienced a case of traumatic posterior dislocation of the left hip associated with fractures of the femoral head and acetabulum, with incomplete sciatic nerve injury and fracture of the proximal end of the tibia.The patient, a 29-year-old man, was injured in a motorcycle accident. As a closed reduction was unsuccessful, an open reduction was performed at thirty six hours after the accident. The lesser fragment was located in the anteromedial portion of the head and showed about a third of the femoral head in size. The fragment of the head was fixed with two screws and acetabular fragment was reattached with silk.After the operation, he was managed with traction for eleven weeks. Nine months later, he had no complaints of the hip and knee joints and x-ray films revealed no progressive changes.