title: [Floating Hip Injuries: Treatment Outcomes and Complications].
abstract: PURPOSE OF THE STUDY The aim of this retrospective study was to evaluate the results of surgical management of patients with ipsilateral injuries to the femur and the pelvis or acetabulum (floating hip). MATERIAL AND METHODS A total of 54 patients with injury to the pelvic ring or acetabulum concomitant with an ipsilateral femoral fracture were treated at our Department in the period from 2005 to 2013. The group consisted of 35 men and 19 women with an average age of 36.5 (22 to 72) years. Only patients undergoing surgery were included. Excluded were patients who died within 48 hours of injury, those whose pelvic injury was treated conservatively and patients with Pipkin type IV fracture. The average follow-up was 6.1 (2 to 10) years. The mechanism of injury included a traffic accident in 36 patients, fall from a height in 15 patients and fall off a horse in two patients; one patient was buried under a collapsed trench wall. Functional outcomes were evaluated using the Harris Hip Score and the Majeed scoring system. RESULTS Of 15 patients with type A fractures (pelvic ring and diaphyseal femur fractures), 12 (80%) had excellent and three (20%) had good results. The outcomes of type B fractures in 28 patients (acetabular and femoral fractures) were excellent in 12 (43%), very good in 10 (36%), good in four (14%) and poor in two (7%) patients. In the sub-group of seven patients with type C fractures (fractures of the pelvic ring and acetabulum with concomitant femoral fracture), the results were satisfactory in five patients (72%), good in one (14%) and poor also in one patient (14%). DISCUSSION The general health status of a patient after traumatic injury is decisive for choosing amongst treatment options of damage control surgery, primary temporary stabilisation and definitive stabilisation. Early definitive stabilisation of fractures gives best results. Primary external fixation of a diaphyseal femur facture with subsequent conversion to internal osteosynthesis, in relation to a change in the patient's general health state within the concept of damage control surgery, has no effect on the functional results of femoral or pelvic fracture treatment. Delayed definitive fixation of an acetabular fracture, however, makes reduction of the fracture more difficult and results in a poorer functional outcome. CONSLUSIONS Injuries to the femur concomitant with pelvic and/or acetabular fractures are serious traumatic events requiring a correct evaluation of the patient's general health status and soft tissue conditions as well as an appropriate treatment timing. The results do not differ from those of treatment for each isolated injury. They are related to types of fracture and experience of the operating team. Complications in floating hip injuries are not higher in number, but their combination may have unpleasant consequences. Key words: floating hip, surgical treatment, complications, outcomes.
authors.affiliation: Klinika ortopedie a traumatologie pohybového ústrojí Fakultní nemocnice Plzeň.
authors.forename: T
authors.initials: T
authors.lastname: Pavelka
authors.forename: M
authors.initials: M
authors.lastname: Salášek
authors.forename: D
authors.initials: D
authors.lastname: Weisová
mesh_terms: D000077:Acetabulum / Q000293:injuries*; D000328:Adult; D000368:Aged; D005260:Female; D005269:Femur / Q000293:injuries*; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult