Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture.

Autor: Milenkovic S; Medical Faculty, University of Nis, Nis, Serbia. sasaortoped@gmail.com.; Clinic for orthopaedic surgery and traumatology, Clinical Centre of Nis, Bul. dr Zorana Djindjica 48, 18000, Nis, Serbia. sasaortoped@gmail.com., Mitkovic M; Medical Faculty, University of Nis, Nis, Serbia.; Clinic for orthopaedic surgery and traumatology, Clinical Centre of Nis, Bul. dr Zorana Djindjica 48, 18000, Nis, Serbia., Mitkovic M; Medical Faculty, University of Nis, Nis, Serbia.
Jazyk: angličtina
Zdroj: European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2022 Feb; Vol. 48 (1), pp. 613-619. Date of Electronic Publication: 2020 Sep 14.
DOI: 10.1007/s00068-020-01495-x
Abstrakt: Purpose: Traumatic hip dislocation can be isolated or associated with acetabular fracture. Both injuries require emergency reduction of the dislocated hip. Avascular necrosis of the femoral head (AVN) is a potential complication that accompanies these severe injuries. Our objective is to identify the risk factors that cause AVN.
Methods: We retrospectively analyzed 44 patients with traumatic hip dislocations (Group A) and patients with posterior fracture-dislocation of the acetabulum (Group B). The average follow-up was 5.38 years in Group A, 5.59 years in Group B. We used the Thompson-Epstein classification for hip dislocation and the Harris Hip Score (HHS) for evaluating final outcomes.
Results: In Group A, we analyzed 21 patients with isolated posterior hip dislocation. We had one (4.76%) case of AVN. In Group B, we analyzed 23 patients with posterior acetabular fracture-dislocation. We had eight (34.78%) patients with AVN (p = 0.016, p < 0.05). With hip reduced 6-12 h after injury, we had AVN in one (4.34%) patient, with reduction 12-24 h, AVN was present in two (8.69%), while in hip reduction done after 24 h of injury, AVN was present in five (21.73%) patients (p = 0.030, p < 0.05).
Conclusion: An essential prerequisite for the prevention of AVN of the femoral head after hip dislocation is emergency hip reduction. In acetabular fracture-dislocation, emergency hip reduction, anatomical reduction of the acetabular fracture and early stable osteosynthesis are also important. Main factor affecting the development of AVN is late reduction of the hip.
(© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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