Traumatic posterior dislocation of the hip: distribution and severity of associated injuries

Posterior hip dislocation is a major orthopaedic injury resulting from high-energy trauma. Morbidity and mortality is very high usually resulting from the associated injuries sustained during the trauma. We carried out this study to find out the usual associated injury distribution and severity in our environment.

This is a five-year prospective multi-center study All patients who presented were recruited into the study. Indices noted included source and time of injury, time of presentation at casualty, associated injuries, injury severity score and the treatment. Presentation was classified as early if less or equal to six hours.

There were 47 patients comprising 36(76.6%) males and 11 (23.4%) females. Forty-six (97.9%) cases resulted from motor vehicular accidents. Mean age was 32.4(+/-9.7) years with 29(80.8%) being less than 40. Thirty-one (65.9%) patients sustained 53 serious injuries that merited admission comprising significant craniofacial laceration 13(24.5%); long bone fractures 12(22.6%); acetabular fractures 9(17.0%); pelvic fractures 9(17.0%); splenic rupture 2(4.3%) and urethral rupture in one (2.1%). These injuries were in combinations. Thirty-two (68.1%) presented early, with twenty-nine (90.7%) presenting within two hours of injury. The mean Injury Severity Score was 20.3 (+/-7.9). Fifteen patients presented late with a mean of 1141 hours (+/-1021) or 6.8 weeks. Ten (66.7%) had no associated injuries while 5(33.3%) had associated injuries comprising three (20.0%) cranio-facial lacerations and two (13.3) had humeral fractures. The mean injury score was 9.0 (+/- 8.0). No mortality was recorded.

This study documented that there was high rate of associated injuries in traumatic posterior hip dislocation each warranting admission on its own merit. These injuries take precedence in the emergency care of patients with posterior dislocation of the hip. The role of public enlightment on road safety measures cannot be over-emphasized and a case is made for training of the populace in essential basic life support.