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Wong MYZ, Ghobrial M, Han WM, Alsousou J, Carrothers A, Hull P, Chou D, Rawal J. The floating hip injury: a descriptive study and case-control analysis. Hip Int 2024; 34:122-133. [PMID: 36912024 PMCID: PMC10787386 DOI: 10.1177/11207000231160075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE A "floating hip" (FH) injury is a rare injury describing the simultaneous ipsilateral fracture of the femur and pelvis or acetabulum (P/A). We describe our experience with patients presenting with FH injuries and compare them to controls with similar P/A fractures but without femoral involvement. METHODS Medical records and radiographs of FH patients and controls presenting to our tertiary centre between 2015 and 2020 were reviewed. Follow-up data from outpatient clinical records were also extracted. The control group were extensively matched by age, sex, body mass index, fracture classification and energy of injury. RESULTS From 1392 recorded P/A fractures, 42 FH cases were identified (average age 39 years, 78.6% males). The most common femoral fracture was the midshaft (35.7%), followed by the neck of femur (26.2%). 90.5% of FH injuries were due to high-energy mechanisms. 64.3% of P/A fractures, and 100% of femoral fractures were managed surgically. Compared to controls, FH cases were more likely to have additional orthopaedic injuries (73.8% vs. 40.5%, p = 0.002), more total theatre admissions (mean 2.5 vs. 1.19, p < 0.001), longer hospital stays (28.3 vs. 14.9 days, p = 0.02), and a higher rates of post-op complications (53.8% vs. 20%, p = 0.025). CONCLUSIONS We report differences in the presentation, management, and outcomes of FH injuries versus controls, even after extensive matching for confounders. These differences may inform future treatment strategies for the FH injury.
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Affiliation(s)
- Mark Y Z Wong
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Marios Ghobrial
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Win M Han
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joseph Alsousou
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrew Carrothers
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter Hull
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daud Chou
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jaikirty Rawal
- Cambridge Orthopaedic Pelvic Unit (COPU), Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Khalifa AA, Mahran DG, Fergany A, Farouk O. Epidemiology of acetabular fractures in elderly patients and the effect of various management options on the outcomes. A comprehensive narrative review. Int J Orthop Trauma Nurs 2023; 53:101049. [PMID: 37852917 DOI: 10.1016/j.ijotn.2023.101049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/02/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023]
Abstract
Owing to the expected increase in the world's elderly population (>65 years old), and the concomitant osteoporosis in this particular population, fragility fractures of the pelvis and the acetabulum is becoming a real concern, which could be life-threatening. In the current review, we aimed to discuss the various epidemiological characteristics of geriatric acetabular fractures, management options, and the outcomes. For the review synthesis, we searched PubMed to select the most relevant and updated articles published from various areas and institutions. Geriatric acetabular fractures are mainly caused by trivial trauma, constitute about 1.5%-3% of all skeletal injuries, and showed a 2.4-fold increase over the past three decades. Furthermore, these fractures' associated one-year mortality rate ranges from 14% to 25%. Management options differ largely according to the type and severity of the injury if there is an associated skeletal or non-skeletal injury, and preexisting patient comorbidities. These options could be nonoperative or operative (including surgical fixation and acute total hip arthroplasty), and both carry a specific risk in this vulnerable age group. There is controversy among various reports regarding the best management option leading to better function and health-related quality of life (HRQoL) outcomes. In conclusion, the incidence of acetabular fractures in elderly patients is rising. The decision-making on the best management option should consider the patient's fragility, injury severity, poor bone quality, and multiple medical comorbidities. The outcomes related to function, quality of life, and mortality are comparable between operative and nonoperative management options.
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Affiliation(s)
- Ahmed A Khalifa
- Orthopaedic Department, South Valley University, Qena, Egypt.
| | - Dalia Galal Mahran
- Department of Public Health and Community Medicine, Assiut University, Assiut, Egypt.
| | - Ali Fergany
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt.
| | - Osama Farouk
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt.
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Nino S, Courington R, Brooks P, Langford J, Haidukewych G. Retrograde Nailing for Extremely Proximal Fractures of the Femoral Shaft. J Orthop Trauma 2023; 37:346-350. [PMID: 36821474 DOI: 10.1097/bot.0000000000002586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To report the results of retrograde intramedullary nailing (RIMN) for the treatment of extremely proximal femur fractures. DESIGN Retrospective cohort study. SETTING Level I trauma center. PATIENTS/PARTICIPANTS 63 patients with femoral shaft fractures involving the anatomic region within 10 centimeters of the inferior border of the lesser trochanter, which were treated with retrograde intramedullary nailing. INTERVENTION Retrograde intramedullary femoral nail. MAIN OUTCOME MEASUREMENTS Time to union, nonunion, malunion, and unplanned reoperation. RESULTS Between 2009 and 2020, 63 fractures were followed up to fracture union, reoperation, or a minimum of 1 year clinically. The mean follow-up was 32 months, and 48 (76%) of the patients were followed up beyond 1 year clinically. The mean patient age was 34 years (range 18-84 years), and the mean BMI was 27 (range 14-45) kg/m 2 . Forty (64%) patients were polytraumatized. Clinical and radiographic union was achieved in 59 (94%) fractures after index operation at a mean time to union of 22 weeks (range 9-51 weeks). Delayed union requiring nail dynamization occurred in 1 (2%) instance. Malreduction was noted in 1 (2%) patient with a 12-degree flexion deformity that resulted in nonunion. In total, there were 3 (5%) nonunions requiring revision surgery, 1 treated with retrograde exchange nailing and 2 revised to cephalomedullary nails; all were united after revision. CONCLUSIONS Retrograde intramedullary nailing can be an effective treatment strategy for extremely proximal femur fractures when necessary. Our series demonstrated a high rate of union and a low rate of malalignment and complications. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Perumal R, Valleri DP, Yalavarthi RK, Tumati SB, Jayaramaraju D, Shanmuganathan R. How Safe is Antegrade Femoral Nailing in Ipsilateral Acetabulum Fractures Requiring Kocher-Langenbeck Approach? An Analysis of 23 Fractures. Indian J Orthop 2021; 56:592-600. [PMID: 35342518 PMCID: PMC8921365 DOI: 10.1007/s43465-021-00544-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/10/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The ipsilateral acetabulum and femur fracture (IAFF) is an uncommon entity. This combination challenges the surgeon in the optimal management of each injury component, fixation sequence, surgical approaches, implant choices and complications. Inappropriate approach for one fracture may affect the fixation of another or modify the overall outcome. In this perspective, we aim to analyze our results in patients who underwent acetabulum fixation with Kocher-Langenbeck (K-L) approach and antegrade femur nailing (AFN), emphasizing the incidence of infection, skin necrosis and heterotopic ossification (HO). METHODS During the five years, 22 patients with 23 IAFF (mean age of 36.5 years) were treated operatively. All the patients underwent K-L approach for acetabulum fixation and AFN for femur fracture. All the patients were treated under the supervision of a pelvi-acetabular trauma consultant. Demographic data, injury, surgical, and postoperative details were collected. The quality of acetabular reduction was evaluated using Matta's criteria. The radiological outcome, obtained at final follow-up, was graded according to Matta's criteria. Functional outcome was evaluated by Merle d'Aubigné and Postel system. HO was graded according to the Brooker system. Complications recorded were DVT, skin necrosis, infection, arthritis, HO, AVN and need for additional surgery. RESULTS Out of 23, 11 had posterior dislocation, 6 had quadrilateral plate injury with central protrusion and six without dislocation. Femur fractures include 9-midshaft, 4-proximal third, 3-distal third, 3-trochanteric fractures and 4-segmental fractures. There were 11 elementary and 12 associated acetabulum fractures. 21 fractures underwent staged-fixation. Single-stage fixation was done in 2. In all cases treated with staged-fixation, AFN was done first. The mean duration of follow-up was 28 months (16-57). All femur fractures united with a mean union time of 21.3 weeks (11-37). The radiological outcome was excellent in 13, good in 4, fair in 3 and poor in 3. The functional outcome was excellent in 3, good in 11, fair in 4 and poor in 4 patients. None had skin necrosis. Three patients had infection. 14 (60.8%) hips had HO, with clinically significant HO (grade 4) in 2(8.6%). Six (26%) patients had arthritic changes. Four (17.3%) hips had avascular necrosis. CONCLUSION AFN is a viable option in IAFFs requiring a K-L approach under the supervision of a pelvi-acetabular surgeon. This combined approach per se does not demonstrate an increased risk of infection, wound healing problems or HO. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00544-w.
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Affiliation(s)
- Ramesh Perumal
- Division of Orthopaedics and Trauma, Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals, 313, Mettupalayam Road, Coimbatore, 641043 India
| | - Durga Prasad Valleri
- Division of Orthopaedics and Trauma, Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals, 313, Mettupalayam Road, Coimbatore, 641043 India
| | - Rakesh Kiran Yalavarthi
- Division of Orthopaedics and Trauma, Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals, 313, Mettupalayam Road, Coimbatore, 641043 India
| | - Shanmuka Babu Tumati
- Division of Orthopaedics and Trauma, Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals, 313, Mettupalayam Road, Coimbatore, 641043 India
| | - Dheenadhayalan Jayaramaraju
- Division of Orthopaedics and Trauma, Department of Orthopaedics and Trauma, Ganga Medical Centre and Hospitals, 313, Mettupalayam Road, Coimbatore, 641043 India
| | - Rajasekaran Shanmuganathan
- Division of Orthopaedics, Trauma and Spine Surgery, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, 641043 India
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Floating hip in polytraumatized patients: complications, mechanism of injury, and surgical strategy. INTERNATIONAL ORTHOPAEDICS 2021; 46:361-368. [PMID: 34779899 DOI: 10.1007/s00264-021-05262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Floating hip fractures are severe and rare injuries with high complication rate and lack of standard management. The purpose of this retrospective study was to review the outcomes of a case series of polytraumatized patients with floating hip injuries, in order to describe the relationship between complication rate and floating hip injury type, the pathomechanism of injury, and the surgical treatment strategy. METHODS Forty-five patients with floating hip injuries were analyzed. Complication rate, mechanism of injury, and surgical strategy (damage control orthopedics, stages of internal fixation) were recorded. Fractures were classified using the Mueller system for floating hips and AO/OTA system for the other fractures. RESULTS Of the 45 patients with floating hip injuries, 23 (51.1%) developed complications. The results revealed that the complication rate was associated with the instability and type of the pelvic or acetabular fracture (61-C AO/OTA pelvic fracture [73.3%; p = 0.04], 62-B AO/OTA acetabular fracture [88.8%; p = 0.03]). Vertical shear (VS) pelvic fractures were related to middle-distal femoral fractures and lateral compression/anteroposterior compression (LC/APC) pelvic lesions were associated to proximal femoral fractures (p = 0.012). CONCLUSIONS Complications were associated with the severity and instability of the pelvic and acetabular type of fractures. The pathomechanism causing Mueller type B and C floating hip injuries was illustrated. A two-stage "femur first" surgical approach was the preferred one for definite internal fixation of fractures.
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Treatment and Complications of Patients With Ipsilateral Acetabular and Femur Fractures: A Multicenter Retrospective Analysis. J Orthop Trauma 2017; 31:650-656. [PMID: 28742784 DOI: 10.1097/bot.0000000000000966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to review the treatment of patients with ipsilateral acetabular and femur fractures to provide descriptive demographic data, injury pattern classification, treatment, and evaluate the complication profile reflective of current practices. STUDY DESIGN Multicenter retrospective cohort. SETTING Eight Level 1 Trauma Centers. PATIENTS/PARTICIPANTS One hundred one patients met inclusion criteria. INTERVENTION Surgical treatment of both the acetabular and femur fractures. MAIN OUTCOME MEASUREMENTS The complications evaluated include avascular necrosis, heterotopic ossification, posttraumatic arthritis, deep venous thrombosis, pulmonary embolism and superficial/deep infection, fracture union, and secondary surgeries. RESULTS Forty-three patients had 31 type fractures (29A; 11B, and 3C), 60 had 32 type (37A, 8B; 15C), and 8 had 33 type (1A, 4B, 3C) femur fractures; 10 patients had combinations involving more than 1 femur fracture pattern. There were 35 62A type fractures, 47 62B, and 19 62C acetabular fractures. Age of 45 or older was associated with marginal impaction (P = 0.001). The aggregate infection rate was 17%. More than 30% of patients required secondary surgeries. The rate of avascular necrosis was higher in acetabular fractures combined with proximal femur fractures (P < 0.05). The rate of deep venous thrombosis was associated with increased age and time to surgical fixation (P < 0.05). CONCLUSIONS We report the largest review of the surgical treatment and complications of ipsilateral acetabular and femoral fractures. This study provides useful information regarding the complications and provides some treatment recommendations regarding these injuries. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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