Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302, Tao-Yuan City, Taiwan.
The Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan branch, Tao-Yuan City, Taiwan.
J Orthop Traumatol. 2022 Dec 2;23(1):55. doi: 10.1186/s10195-022-00677-0.
For hip posterior fracture-dislocation, the current consensus is to perform joint reduction within 6 h to prevent sequelae. However, whether a closed reduction (CR) should be performed at the emergency department (ED) or in the operation theater (OT) remains debatable. We aimed to assess the incidence and factors predictive of CR failure at the ED in patients with hip posterior fracture-dislocation.
Patients with hip posterior fracture-dislocation between 2009 and 2019 were included. Age, sex, body mass index (BMI), injury severity score, new injury severity score, time from injury to first reduction attempt (TIR), presence of associated femoral head fracture, posterior wall marginal impaction, and posterior wall fragment size were compared between patients with CR success and patients with CR failure at the ED.
Fifty-five patients with hip posterior fracture-dislocation experienced CR attempts at the ED and were enrolled in the study. Thirty-eight (69.1%) hips were reduced successfully at the ED, and 17 (30.9%) experienced failure. No significant differences in age, sex, BMI, presence of femoral head fracture, marginal impaction, or size of the posterior wall fragment were found between the groups. TIR was significantly shorter in the successful CR group (2.24 vs. 4.11 h, p = 0.01). According to receiver operating characteristic curve analysis, 3.5 h was the cut-off time.
For patients with hip posterior fracture-dislocation, TIR was a critical factor for successful CR. If the time interval exceeds 3.5 h from injury, the success rate of bedside CR at the ER is likely to decrease, and the OT should be prepared in case of failed bedside CR.
对于髋关节后脱位骨折，目前的共识是在 6 小时内进行关节复位，以防止出现后遗症。然而，在急诊室（ED）还是手术室（OT）进行闭合复位（CR）仍存在争议。我们旨在评估髋关节后脱位骨折患者在 ED 行 CR 失败的发生率和预测因素。
纳入 2009 年至 2019 年期间髋关节后脱位骨折的患者。比较 ED 行 CR 成功和失败患者的年龄、性别、体重指数（BMI）、损伤严重程度评分、新损伤严重程度评分、从受伤到首次复位尝试的时间（TIR）、是否存在股骨头骨折、后侧壁边缘嵌顿和后侧壁骨折块大小。
55 例髋关节后脱位骨折患者在 ED 行 CR 尝试，并纳入本研究。38 髋（69.1%）在 ED 成功复位，17 髋（30.9%）复位失败。两组患者在年龄、性别、BMI、股骨头骨折、边缘嵌顿或后侧壁骨折块大小方面无显著差异。成功 CR 组的 TIR 明显更短（2.24 小时 vs. 4.11 小时，p=0.01）。根据受试者工作特征曲线分析，3.5 小时是截断时间。
对于髋关节后脱位骨折患者，TIR 是 CR 成功的关键因素。如果从受伤到床边复位的时间间隔超过 3.5 小时，ER 床边 CR 的成功率可能会降低，应准备在床边 CR 失败时转至 OT。
