Hip Dislocations and Femoral Head Fractures：髋关节脱位，股骨头骨折.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 3. Incarcerated Fragment Can be detected on x-ray or CT scan. Surgical removal necessary to prevent abrasive wear of the articular cartilage. Posterior approach allows best visualization of acetabulum (with distraction or intra-op dislocation). Anterior approach only if: dislocation was anterior and, fragment is readily accessible anteriorly. 4. Incongruent Reduction From: Acetabulum Fracture (weight-bearing portion). Femoral Head Fracture (any portion). Interposed tissue. Goal: achieve congruence by removing interposed tissue and/or reducing and stabilizing fracture. 5. Unstable Hip after Reduction Due to posterior wall and/or femoral head fracture. Requires reduction and stabilization fracture. Labral detachment or tear Highly uncommon cause of instability. Its presence in the unstable hip would justify surgical repair. MRI may be helpful in establishing diagnosis. Results of Treatment Large range: from normal to severe pain and degeneration. In general, dislocations with associated femoral head or acetabulum fractures fare worse. Dislocations with fractures of both the femoral head and the acetabulum have a strong association with poor results. Irreducible hip dislocations have a strong association with poor results. 13/23 (61%) poor and 3/23 (13%) fair results. McKee, Garay, Schemitsch, Kreder, Stephen. Irreducible fracture-dislocation of the hip: a severe injury with a poor prognosis. J Orthop Trauma. 1998.  Complications of Hip Dislocation Avascular Necrosis (AVN): 1-20% Several authors have shown a positive correlation between duration of dislocation and rate of AVN. Results are best if hip reduced within six hours. Post-traumatic Osteoarthritis Can occur with or without AVN. May be unavoidable in cases with severe cartilaginous injury. Incidence increases with associated femoral head or acetabulum fractures. Efforts to minimize osteoart