Irreducible fracture-dislocation of the hip: a severe injury with a poor prognosis.

OBJECTIVE

To determine the outcome of and prognostic factors associated with irreducible fracture-dislocations of the hip.

DESIGN

Retrospective review of a prospectively gathered trauma database.

METHODS

Using a prospectively gathered trauma database, we identified twenty-five patients with fracture-dislocations of the hip that were irreducible with closed means under a general anaesthetic. All were victims of high-energy trauma with severe injuries (mean Injury Severity Score = 25, range 9 to 54). Eighteen patients had multiple fractures, fifteen had associated systemic injury, and only four sustained the hip injury in an isolated fashion. There were seven associated sciatic nerve injuries (28 percent) and nine associated femoral head or neck fractures (36 percent). The mean time from injury to open reduction was 15.3 hours (range 3 to 58 hours).

RESULTS

Twenty-three patients (92 percent) were followed to definitive outcome. Despite accurate reduction, only six patients had satisfactory results (Thompson-Epstein = good or excellent). Poor results were associated with delay in reduction and an associated femoral head or neck fracture. Reasons for the poor results include avascular necrosis, posttraumatic arthritis or chondrolysis, persisting sciatic nerve injury, and heterotopic ossification.

CONCLUSIONS

An irreducible fracture-dislocation of the hip is a severe injury with a poor prognosis and a high incidence of associated injuries. Outcome is best in patients who do not have an associated femoral head or neck fracture and those whose dislocation is promptly reduced.