Massoud EIE. Neglected traumatic hip dislocation: Influence of the increased intracapsular pressure. World J Orthop 2018; 9(3): 35-40 [PMID: 29564212 DOI: 10.5312/wjo.v9.i3.35]
Corresponding Author of This Article
Elsayed Ibraheem Elsayed Massoud, MD, MSc, Professor, Department of Orthopaedic, Sohag Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Nil street, Sohag 0026280, Egypt. elsayedmassoud@hotmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Mar 18, 2018; 9(3): 35-40 Published online Mar 18, 2018. doi: 10.5312/wjo.v9.i3.35
Neglected traumatic hip dislocation: Influence of the increased intracapsular pressure
Elsayed Ibraheem Elsayed Massoud
Elsayed Ibraheem Elsayed Massoud, Department of Orthopaedic, Sohag Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Sohag 0026280, Egypt
Author contributions: Massoud EIE has made all of the following: (1) The conception and design of the study, acquisition of data, analysis and interpretation of data; (2) drafting the article and revising it critically for important intellectual content; and (3) final approval of the version to be submitted.
Institutional review board statement: This study was reviewed and approved by the Local Ethics Committee of the Sohag Teaching Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient or his relatives agreed to treatment by written consent.
Conflict-of-interest statement: Author declares no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Elsayed Ibraheem Elsayed Massoud, MD, MSc, Professor, Department of Orthopaedic, Sohag Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Nil street, Sohag 0026280, Egypt. elsayedmassoud@hotmail.com
Telephone: +2-93-4790632
Received: December 24, 2017 Peer-review started: December 25, 2017 First decision: January 6, 2018 Revised: January 12, 2018 Accepted: February 4, 2018 Article in press: February 5, 2018 Published online: March 18, 2018 Processing time: 81 Days and 10.8 Hours
Abstract
AIM
To investigate that the increased intracapsular pressure, during the delay period, can interrupt the blood flow to the femoral head.
METHODS
An observational retrospective study included a group of 17 patients with traumatic hip dislocation, their ages at time of injury averaged 26 (range from 3 to 70) years. Outcomes were assessed clinically and radiographically at a period averaged 11.5 (range from 4 to 20) years.
RESULTS
Minor trauma caused dislocation in seven and severe trauma in ten patients. All dislocations were posterior, six isolated dislocation and 11 were associated with other injuries. The negligence period averaged 2.5 (ranged from 1 to 4) d. At the latest visit, the radiography revealed normal hip in 11 and avascular necrosis (AVN) in six patients. Clinically, eight patients were rated as excellent, three good, three fair and three poor.
CONCLUSION
We believe the factors that contribute to increased intracapsular pressure also increase the influence of delayed reduction toward the development of AVN.
Core tip: Factors influencing outcomes of traumatic hip dislocation include reduction time, the severity of trauma, patients’ ages and direction of dislocation. Although these factors have been thoroughly investigated, any of them was not assigned as the causative for the development of the avascular necrosis (AVN). Does the increased intracapsular pressure is the foremost factor? We believe that the factors as hemarthrosis, the position of the limb during the pre-reduction period particularly in posterior dislocation and traction in post-reduction period can increase the intracapsular pressure to a level sufficient for occlusion of intracapsular blood vessels. Delayed reduction accentuates influence of increased intracapsular pressure in favour of the development of AVN.
