Hip dislocation in patients with multiple injuries. A followup investigation

The combination of traumatic hip dislocation and multiple trauma have not been well documented in the medical literature to date. The role of surgery therefore has not been well defined in these patients. During a 12-year period, 29 consecutive patients with 31 traumatic hip dislocations with concomitant Injury Severity Scores exceeding 18 points were treated at the authors' institution. An initial satisfactory closed reduction was achieved in 23 patients, two patients had failed reductions, and four patients had noncongruous reductions. Open surgical procedures were done on these patients and on 10 additional patients who had associated acetabular or femoral head fractures. Overall, seven patients from the group died including two patients who had surgical procedures. From 17 living patients who did not require surgery for failed or noncongruous reductions, 13 patients were available for followup at a mean of 8 years after their injury. The clinical results at this followup were excellent in three hips, good in seven hips, and fair in four hips. The radiologic results, however, showed that five patients had early (Grades I and II according to Matta) hip degeneration and seven patients had Grade II (according to Ficat) avascular necrosis of the femoral head. These changes were not clinically significant at this followup and it is proposed that these results justify a policy of active treatment of traumatic hip dislocation in patients with multitrauma.