Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture

Abstract

Purpose

Traumatic hip dislocation can be isolated or associated with acetabular fracture. Both injuries require emergency reduction of the dislocated hip. Avascular necrosis of the femoral head (AVN) is a potential complication that accompanies these severe injuries. Our objective is to identify the risk factors that cause AVN.

Methods

We retrospectively analyzed 44 patients with traumatic hip dislocations (Group A) and patients with posterior fracture–dislocation of the acetabulum (Group B). The average follow-up was 5.38 years in Group A, 5.59 years in Group B. We used the Thompson–Epstein classification for hip dislocation and the Harris Hip Score (HHS) for evaluating final outcomes.

Results

In Group A, we analyzed 21 patients with isolated posterior hip dislocation. We had one (4.76%) case of AVN. In Group B, we analyzed 23 patients with posterior acetabular fracture–dislocation. We had eight (34.78%) patients with AVN (p = 0.016, p < 0.05). With hip reduced 6–12 h after injury, we had AVN in one (4.34%) patient, with reduction 12–24 h, AVN was present in two (8.69%), while in hip reduction done after 24 h of injury, AVN was present in five (21.73%) patients (p = 0.030, p < 0.05).

Conclusion

An essential prerequisite for the prevention of AVN of the femoral head after hip dislocation is emergency hip reduction. In acetabular fracture–dislocation, emergency hip reduction, anatomical reduction of the acetabular fracture and early stable osteosynthesis are also important. Main factor affecting the development of AVN is late reduction of the hip.

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Acknowledgements

This manuscript is supported by the Medical faculty, University of Niš, internal project titled “Total hip arthroplasty after earlier acetabular fractures” and the project “Virtual human osteoarticular system and its application in preclinical and clinical practice” (project no. III41017) funded by the Ministry of Education, Science and Technological Development of the Republic of Serbia.

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No financial support was received for this study.

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Correspondence to Sasa Milenkovic.

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This study was approved by the appropriate ethics committee.

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Informed consent was not necessary for this study with its retrospective design and anonymised data and thus not requested from our patients.

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Milenkovic, S., Mitkovic, M. & Mitkovic, M. Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture. Eur J Trauma Emerg Surg (2020). https://doi.org/10.1007/s00068-020-01495-x

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Keywords

  • Traumatic hip dislocation
  • Acetabular fracture–dislocation
  • Avascular necrosis of the femoral head