Result of conservative management in central fracture dislocation of hip

The central fracture dislocation of hip involves displacement of medial wall and superior weight bearing dome of acetabulum. The management of this type of fracture is to be planned after meticulous clinical and radiological planning of the personality of fracture along with status of the patient. Ideally displaced fracture should be treated by anatomic reduction, stable internal fixation and early non-weight bearing exercises. But considering the complications of open reduction and internal fixation we must take into account the "risk benefit equation" ie, to measure the benefit gained against the risk of surgery. Dynamic stress fluoroscopic examination under general anaesthesia was performed to assess the need for surgical treatment for central fracture dislocation of hip. Stable hips were treated nonoperatively, and unstable hips were treated by open reduction and internal fixation. Every patient had routine clinical and radiographic follow-up at one week, three weeks, six weeks, three months, six months, and one year after the injury and then on yearly basis. Harris' hip score was used for evaluation. Institutional review board approval was obtained prior to initiation of this study. All 14 patients in this study were evaluated radiologically and functionally for a minimum of two years after the injury (average 2 years; range 2 to 5 years) and were graded as excellent, good, fair and poor using the Harris' hip score. Excellent results were obtained in 6 cases (42.85%), good results in 3 cases (21.42%), fair results in 4 cases (28.57%) and poor result in one case (7.14%). Central fracture dislocation of hip is an intra-articular fracture of weight bearing joint, so it is supposed to be managed better by open reduction and stable Internal fixation followed by early movement. But with meticulous evaluation and selection of cases, proper conservative management gives comparable results to the open reduction and internal fixation group even in young patients where secondary congruency is achieved. To conclude conservative management is an effective modality of treatment in appropriate cases of central fracture dislocation of hip.