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The floating hip injury: which should we fix first?

  • T. SuzukiEmail author
  • M. Shindo
  • K. Soma
Original Article

Abstract

In floating hip injuries, the priority of the steps in fixation has not been well described. We have treated these patients in accordance with the following protocols. In patients with pelvic ring fractures, the external fixation should be performed first, and in patients with acetabular fractures, the femoral fractures should be internally fixated first. The purpose of the present study was to review our experience with these fracture treatments to evaluate our strategy. For 8 years, 31 patients with femoral fractures associated with ipsilateral fractures: 26 unstable pelvic ring fractures and 7 unstable acetabular fractures were surgically treated at our level 1 trauma center. We reviewed the admission, operation, and follow-up records retrospectively and evaluated the order of the fixation and the complications. Two patients with acetabular fractures failed to follow our protocol outlined at the preoperative planning stage. There were no surgical difficulties other than two patients with the hemipelvis dislocated proximally who required traction of the fixated femur. The complications that were thought to be related to our protocol were one fat embolism syndrome and one pubic fracture displacement. One heterotopic ossification seemed to occur due to using a single approach for both fractures. We believe our protocol to be generally effective, however, in patients with acetabular and vertical shear type pelvic ring fractures, the internal or external fixation of the femur should be performed before the internal fixation of the pelvis.

Keywords

Ipsilateral fractures Pelvic ring fractures Acetabular fracture Femoral fractures Floating hip 

Les lésions traumatiques flottantes de la hanche: Que devrions-nous fixer d’abord?

Résumé

Dans les traumatismes flottants de la hanche, la hiérarchie des fixations stabilisatrices n’est guère précise. Nous avons traité ce type de patients selon le protocole qui suit. Chez les patients présentant une fracture de l’anneau pelvien, la fixation externe doit être faite en premier et chez ceux ayant une fracture du cotyle, les fractures fémorales doivent être fixées en premier par enclouage. Le propos de ce travail a été d’analyser notre expérience et d’évaluer notre stratégie. En 8 ans, 31 patients ayant une fracture du fémur associée du même côté à une lésion pelvienne, soit 26 fractures instables de l’anneau pelvien et 7 fractures instables du cotyle, ont été traités chirurgicalement dans notre centre. Nous pensons en conclusion que notre protocole est généralement efficace, cependant chez des patients ayant à la fois une fracture du cotyle et un cisaillement vertical avec fracture de l’anneau pelvien, l’ostéosynthèse par enclouage ou par fixateur externe du fémur doit être effectuée avant l’ostéosynthèse interne du bassin.

Mots clés

Fractures homolatérales Fractures de l’anneau pelvien Fracture du cotyle Fractures du fémur Hanche flottante 

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Emergency Medicine and Critical Care CenterKitasato University School of MedicineSagamiharaJapan
  2. 2.Department of Emergency and Critical Care Medicine Showa University School of MedicineTokyoJapan

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