The Cause of Primary Reduction Failure in Hip Dislocation with or without Hip Fracture

Hee-Gon Park; Yong-Eun Shin; Sung-Hyun Kim

doi:10.12671/jkfs.2017.30.1.9

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Park, Shin, and Kim: The Cause of Primary Reduction Failure in Hip Dislocation with or without Hip Fracture

Original Article

Journal of the Korean Fracture Society 2017; 30(1): 9-15.

Published online: 20 January 2017

DOI: https://doi.org/10.12671/jkfs.2017.30.1.9

The Cause of Primary Reduction Failure in Hip Dislocation with or without Hip Fracture

Hee-Gon Park, M.D., Yong-Eun Shin, M.D., Sung-Hyun Kim, M.D.

Department of Orthopedic Surgery, Dankook University Hospital, Cheonan, Korea.

Correspondence to: Hee-Gon Park, M.D. Department of Orthopedic Surgery, Dankook University Hospital, 201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea. Tel: +82-41-550-6290, Fax: +82-41-556-0551, arod@naver.com

Received 13 March 2016 Revised 22 September 2016 Accepted 8 October 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

A rapid and accurate reduction is important for hip dislocated patients to avoid various potential complications, including avascular necrosis of the femoral head. We analyzed hip dislocation cases, ones that particularly failed during the primary reduction trial.

Materials and Methods

Eighty-seven patients with hip dislocation, who visited the emergency department between January 2007 and September 2015, were retrospectively analyzed. Of them, 68 patients were successfully treated in the first closed reduction trial, and the remaining 19 patients were unsuccessful. Of the 19 unsuccessful first trial, 12 patients were successfully treated in the second closed reduction; however, in the remaining 7 patients, open reduction was performed in the operation room with general anesthesia. Every closed reduction was practiced by at least 2 orthopedic doctors, and open reduction was performed by a single senior author.

Results

The rate of first reduction failure was higher, with statistical significance, in patients aged under 50 years, male gender, and those with combined around hip fractures, including femoral head and acetabular fracture (p<0.05). In particular, the presence of impacted fracture fragment in the hip joint and large size of the impacted fracture fragment was highly related to the failure of second closed reduction trial requiring open reduction. Conversely, the method of reduction, Thompson-Epstein classification, Pipkin classification were not related to the failure of closed reduction statistically (p>0.05).

Conclusion

To evaluate the patients with hip dislocation, realizing the type of dislocation, presence of accompanied fracture, location and size of fracture fragment, age, as well as gender of patients is important. If the fracture fragment is impacted in the hip joint and the size of the fragment is large, then the operative treatment is considered, rather than the repetitive trial of closed reduction by constraint.

Keywords: Hip joint, Dislocation, Fracture, Closed reduction, Reduction failure

Figures and Tables

Fig. 1

Measurement method of volume of the bone fragment.

Fig. 2

Overview of cases. ER: emergency room, OR: operation room.

Fig. 3

Relationship between 2nd closed reduction failure and volume of the bone fragment.

Fig. 4

Case: Closed reduction was interrupted by a large bone fragment.

Table 1

Patient Distribution of Age

Values are presented as number only or number (%). The sum of the percentages does not equal 100% because of rounding.

Table 2

Injury Mechanism

TA: traffic accident, Others: bicycle accident, slip down, crushing injury, etc.

Table 3

Relationship between Age and First Reduction Failure

Table 4

Relationship between Reduction Method and First Reduction Failure

Table 5

Odds Ratio of First Reduction Failure by Logistic Regression Analysis

Notes

^{Financial support} None.

^{Conflict of interest} None.

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