Complications and outcomes in 69 consecutive patients with floating hip
Alexandre Cech, Clémentine Rieussec, Gaël Kerschbaumer, Olivier Seurat, Clémentine Corbet, Benoît Vibert, Camille Tronc, Sébastien Ruatti, Pierre Bouzat, Jérôme Tonetti, Mehdi Boudissa, Alexandre Cech, Clémentine Rieussec, Gaël Kerschbaumer, Olivier Seurat, Clémentine Corbet, Benoît Vibert, Camille Tronc, Sébastien Ruatti, Pierre Bouzat, Jérôme Tonetti, Mehdi Boudissa
Abstract
Background: Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip.
Hypothesis: A standardized strategy with specialised multidisciplinary management is associated with a low mortality rate.
Methods: Consecutive patients who had surgery to treat floating hip between January 2010 and December 2019 were included in this single-centre retrospective study. Epidemiological, clinical, and radiological data were collected and analysed. Patients were managed according to a standardised strategy adapted to the haemodynamic status and type of floating hip (type A, femoral and pelvic ring fractures; type B, femoral and acetabular fractures; and type C, femoral, acetabular, and pelvic ring fractures). The clinical outcome at last follow-up was determined by a telephone interview, based on the Majeed and Oxford scores, sports resumption, and work resumption. To assess the radiological outcomes, we applied Matta's criteria for the acetabulum and Tornetta's criteria for the pelvic ring.
Results: We included 69 patients with a mean age of 38.5 years. Among them, 39 (57%) had haemodynamic instability requiring embolisation (n=15, 22%) or multiple blood transfusions (n=24, 35%). Type A injuries predominated (n=57, 83%). The need for multiple blood transfusions was significantly associated with type C floating hip, underlining the risk of heavy bleeding with this injury. Two (3%) patients died. When management was complete, the reduction was anatomical or satisfactory for 76% (13/17) of the acetabula according to Matta's criteria (maximum residual displacement <3mm) and for 85% (56/66) of the pelvic rings according to Tornetta's criteria (maximum residual displacement <10mm). One or more complications occurred in 45 (65%) patients. After a mean follow-up of 5 years, the mean Oxford Hip Score in patients with acetabular fractures was 35.5 and the mean Majeed score in patients with pelvic ring fractures was 71.5. Only 30% of patients were able to resume physical activities at the former level and to return to their former professional activities.
Conclusion: Type C floating hip, which combines fractures of the pelvic ring and acetabulum, carries a high risk of bleeding. Special attention should be directed to the reduction of pelvic ring fractures, to avoid malunion. Acetabular fractures that are complex in the Letournel classification carry a risk of imperfect reduction. The results of this study confirm the severity of these rare injuries and the need for specialised multidisciplinary management according to a standardised strategy that is appropriate for the haemodynamic status and type of floating hip (A, B, or C).
Level of evidence: IV; retrospective study.
Keywords: Acetabular fracture; Femoral fracture; Floating hip; Ipsilateral fractures; Pelvic ring fracture.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
Source: PubMed