Treatment of Traumatic Posterior Fracture and Dislocation of the Hip

Kim, Dong Hui; Lee, Sang Hong; Kim, Jeoung Ho

Abstract

Purpose
To evaluate outcomes and complications after traumatic posterior hip fractures and dislocations classified according to the Thompson-Epstein system.
Materials and Methods
Thirty-five cases were selected from among the patients we treated between January 2000 and December 2005. According to Thompson-Epstein classification, 5 cases were type I, 7 cases were type II, 5 cases were type III, 8 cases were type IV, and 10 cases were type V. The mean age at the time of injury was 41 years (range: 19~72 years). Twenty-six patients were men, and 9 patients were women. The mechanisms of injury included traffic accidents in 30 cases and falls in 5 cases. The mean follow-up period was 31 months (range: 13~86 months). Fracture reduction was achieved within 6 hours in 32 cases. Thirty-four patients underwent closed reduction, and 22 of these patients were treated using Allis'method.
Results
All Thompson-Epstein type I fractures were managed with closed reduction. Two type II fractures were treated conservatively, and 4 were treated with open reduction and internal fixation. All 13 type III and IV fractures were treated using open reduction and internal fixation. Six type V fractures were treated conservatively, 4 were treated with open reduction and internal fixation, and 1 was treated using total hip arthroplasty. Posttraumatic arthritis was observed in 9 cases, 7 of which were Thompson-Epstein type IV. Avascular necrosis (AVN) of the femoral head and deep vein thrombosis were observed in 1 case. Sciatic nerve injury was seen in 5 cases.
Conclusion
Complications often occur in Thompson-Epstein type IV fractures. We believe that early, appropriate anatomical reduction helps to improve outcomes.