Skip to main content

Advertisement

SpringerLink
Log in

Hospital transfer and delayed reduction of traumatic hip dislocations

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Native hip dislocations are high energy injuries that cause substantial patient morbidity. Expedient reduction has been demonstrated to improve patient outcomes. The objective of our study was to compare complication rates in patients with native hip dislocations who presented directly to a level-one trauma center with those transferred from an outside hospital (OSH). Our hypothesis was that those transferred from an OSH would experience a delay in reduction and subsequently would experience higher rates of avascular necrosis (AVN), post-traumatic arthritis (PTA), and need for secondary surgery.

Material and methods

We conducted a retrospective chart review of all native hip dislocations from our level-one trauma center between January 2007 and December 2020. The initial query resulted 628 patients which was refined to 90 patients after excluding patients for incorrect diagnosis code or less than 6 months of follow-up. Our primary outcome was the development of AVN, PTA, and need for secondary surgery. Time from injury to reduction was recorded for all patients included.

Results

For every one hour of delay in time to reduction, there was a 3.4% increase in the risk of developing AVN (p = 0.004) and a 4.3% increase in risk for developing PTA (p = 0.01). The risk of requiring a secondary surgery increased 4.6% for each hour of delay in reduction (p = 0.03). The average time to reduction of transferred patients was higher compared to those who presented directly to our center (13.8 h vs 5.7 h); however, transfer status was not found to be an independent risk factor for the measured outcomes.

Conclusions

Transfer status is not an independent risk factor for the development of AVN, PTA, or the need for a secondary surgery. However, transferred patients did experience an average delay of 8 h in time to reduction compared to those who presented directly to a trauma center. Of the 27 patients with a reduction delay greater than 12 h, 26 (96%) were transferred.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data utilized for this study is available upon request.

References

  1. Clegg TE et al (2010) Hip dislocations–epidemiology, treatment, and outcomes. Injury 41(4):329–334

    Article  PubMed  Google Scholar 

  2. Stewart MJ, Milford LW Fracture-dislocation of the hip; an end-result study. J Bone Joint Surg Am, 1954. 36(A:2): 315–42.

  3. Arnold C et al (2017) Managing dislocations of the hip, knee, and ankle in the emergency department. Emerg Med Pract 19(12):1–28

    PubMed  Google Scholar 

  4. Foulk DM, Mullis BH (2010) Hip dislocation: evaluation and management. J Am Acad Orthop Surg 18(4):199–209

    Article  PubMed  Google Scholar 

  5. Kellam P, Ostrum RF (2016) Systematic review and meta-analysis of avascular necrosis and posttraumatic arthritis after traumatic hip dislocation. J Orthop Trauma 30(1):10–16

    Article  PubMed  Google Scholar 

  6. Dwyer AJ et al (2006) Complications after posterior dislocation of the hip. Int Orthop 30(4):224–227

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Nicholson JA et al (2018) Native hip dislocation at acetabular fracture predicts poor long-term outcome. Injury 49(10):1841–1847

    Article  CAS  PubMed  Google Scholar 

  8. Yang RS et al (1991) Traumatic dislocation of the hip. Clin Orthop Relat Res 265:218–227

    Article  Google Scholar 

  9. Giannoudis PV et al (2009) Management, complications and clinical results of femoral head fractures. Injury 40(12):1245–1251

    Article  CAS  PubMed  Google Scholar 

  10. Milenkovic S, Mitkovic M (2022) Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture. Eur J Trauma Emerg Surg 48(1):613–619

    Article  PubMed  Google Scholar 

  11. Hougaard K, Thomsen PB (1987) Coxarthrosis following traumatic posterior dislocation of the hip. J Bone Joint Surg Am 69(5):679–683

    Article  CAS  PubMed  Google Scholar 

  12. Brav EA Traumatic Dislocation of the Hip: Army Experience and Results over a Twelve-Year Period. 1952, J Bone Joint Surg 1115–1134.

  13. Hillyard RF, Fox J (2003) Sciatic nerve injuries associated with traumatic posterior hip dislocations. Am J Emerg Med 21(7):545–548

    Article  PubMed  Google Scholar 

  14. Lin DY, Wei LJ, Ying Z Checking the Cox model with cumulative sums of martingale-based residuals. 1993: Biometrika. p. 557–572.

  15. Peduzzi P et al (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49(12):1373–1379

    Article  CAS  PubMed  Google Scholar 

  16. Agresti A, Analysis of Ordinal Categorical Data. 2010, Wiley.

  17. Schemper M, Smith TL (1996) A note on quantifying follow-up in studies of failure time. Control Clin Trials 17(4):343–346

    Article  CAS  PubMed  Google Scholar 

  18. Smith GR, Loop JW (1976) Radiologic classification of posterior dislocations of the hip: refinements and pitfalls. Radiology 119(3):569–574

    Article  CAS  PubMed  Google Scholar 

  19. Romeo NM, Firoozabadi R (2018) Classifications in brief: the pipkin classification of femoral head fractures. Clin Orthop Relat Res 476(5):1114–1119

    Article  PubMed  PubMed Central  Google Scholar 

  20. Wang S et al (2021) Early versus delayed hip reduction in the surgical treatment of femoral head fracture combined with posterior hip dislocation: a comparative study. BMC Musculoskelet Disord 22(1):1057

    Article  PubMed  PubMed Central  Google Scholar 

  21. Milenkovic S, Mitkovic M, Mitkovic M (2022) Avascular necrosis of the femoral head after traumatic posterior hip dislocation with and without acetabular fracture. Eur J Trauma Emerg Surg 48(1):613–619

    Article  PubMed  Google Scholar 

  22. Ahmed G et al (2017) Late versus early reduction in traumatic hip dislocations: a meta-analysis. Eur J Orthop Surg Traumatol 27(8):1109–1116

    Article  PubMed  Google Scholar 

  23. Sahin V et al (2003) Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study. J Trauma 54(3):520–529

    Article  PubMed  Google Scholar 

  24. Cash DJ, Nolan JF (2007) Avascular necrosis of the femoral head 8 years after posterior hip dislocation. Injury 38(7):865–867

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

There was no financial support for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA

    Patrick C. McGregor, Jason E. Meldau, Tomas Liskutin, Robert F. Kelly, Ashley E. Levack, Joseph Cohen & Hobie Summers

Authors
  1. Patrick C. McGregor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jason E. Meldau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomas Liskutin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert F. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ashley E. Levack
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joseph Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hobie Summers
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

PCM MD—data collection, analysis, manuscript drafting. JEM MD—data collection, analysis, manuscript drafting. TL MD—data collection, analysis, manuscript drafting. RFK—data collection, analysis, manuscript drafting. AEL MD—project conception/design, manuscript drafting, manuscript editing. JC MD—project conception/design, manuscript drafting, manuscript editing. HS MD—project conception/design, manuscript drafting, manuscript editing.

Corresponding author

Correspondence to Jason E. Meldau.

Ethics declarations

Conflict of interest

Patrick C. McGregor MD—None. Jason E. Meldau MD—None. Tomas Liskutin MD—None. Robert F. Kelly—None. Ashley E. Levack MD—orthopaedic trauma association: board or committee member. Joseph Cohen MD—None. Hobie Summers MD—AONA trauma education committee: board or committee member.

Ethical approval

Approval by our institution’s IRB committee.

Informed consent

Exempt.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McGregor, P.C., Meldau, J.E., Liskutin, T. et al. Hospital transfer and delayed reduction of traumatic hip dislocations. Arch Orthop Trauma Surg 143, 4785–4791 (2023). https://doi.org/10.1007/s00402-023-04768-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-023-04768-3

Keywords

Search

Navigation