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KMID : 0386720080200020138
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Journal of the Korean Hip Society
2008 Volume.20 No. 2 p.138 ~ p.145
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Treatment of Traumatic Posterior Fracture and Dislocation of the Hip
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Kim Dong-Hwi
Lee Sang-Hong
Kim Jung-Ho
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Abstract
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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.
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KEYWORD
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Posterior dislocation of the hip, Thompson-Epstein type
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