Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture
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ORIGINAL ARTICLE
Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture Sasa Milenkovic1,2 · Milan Mitkovic1,2 · Milorad Mitkovic1 Received: 28 February 2020 / Accepted: 4 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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 24 h
4 (17.39%)
6 (26.08%)
6 (26.08%)
7 (30.43%)
Interval between injury and time of hip reduction. Median value equals 18 h, interquartile range (IQR) value equals 40 h
hip reduction was done with open method within the same surgical procedure as osteosynthesis of acetabulum. AVN of the femoral head in this group was present in eight (34.78%) patients, which is considerably more compared to group A (4.76% vs 34.78%, p = 0.016, p 24 h after the injury AVN of femoral head was found (p = 0.030, p 24 h, one hip was reduced by closed method after 6 days, and four by open method (one after 7 days, one after 14 days, and one after 3 weeks from injury). Patients who had hip reduction done 7 days after or later, AVN of the femoral head was 100%. Interval between injury and time of definitive osteosynthesis of the acetabulum is shown in Table 5. Anatomical reduction of the acetabular fracture (≤ 2 mm), in group B was accomplished in 19 (82.60%) patients. Final
Fig. 3 AVN of the femoral head after traumatic posterior hip dislocation (Group A) is 4.76%. AVN after acetabulum fracture–diskocation (Group B) is 34.78% (4.76 vs 34.78%)
functional results according to Harris Hip Score (HHS) are excellent in ten (43.47%), good in six (26.08%), moderate in five (21.73%) and poor in two (8.69%) (Fig. 4). Total hip arthroplasty (THA) required eight (34.78%) patients (Fig. 5).
Discussion Traumatic hip dislocation, isolated, or associated with acetabular fracture [13], represents emergency in the traumatology. These injuries mostly occur in motor vehicle accidents [1, 14] by action of high energy axial forces, their treatment regarding final functional outcome is always uncertain. Whether isolated posterior hip dislocation or posterior hip dislocation with acetabular frac
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