Department of Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL, 60153, USA.
Arch Orthop Trauma Surg. 2023 Aug;143(8):4785-4791. doi: 10.1007/s00402-023-04768-3. Epub 2023 Feb 7.
Native hip dislocations are high energy injuries that cause substantial patient morbidity. Expedient reduction has been demonstrated to improve patient outcomes. The objective of our study was to compare complication rates in patients with native hip dislocations who presented directly to a level-one trauma center with those transferred from an outside hospital (OSH). Our hypothesis was that those transferred from an OSH would experience a delay in reduction and subsequently would experience higher rates of avascular necrosis (AVN), post-traumatic arthritis (PTA), and need for secondary surgery.
We conducted a retrospective chart review of all native hip dislocations from our level-one trauma center between January 2007 and December 2020. The initial query resulted 628 patients which was refined to 90 patients after excluding patients for incorrect diagnosis code or less than 6 months of follow-up. Our primary outcome was the development of AVN, PTA, and need for secondary surgery. Time from injury to reduction was recorded for all patients included.
For every one hour of delay in time to reduction, there was a 3.4% increase in the risk of developing AVN (p = 0.004) and a 4.3% increase in risk for developing PTA (p = 0.01). The risk of requiring a secondary surgery increased 4.6% for each hour of delay in reduction (p = 0.03). The average time to reduction of transferred patients was higher compared to those who presented directly to our center (13.8 h vs 5.7 h); however, transfer status was not found to be an independent risk factor for the measured outcomes.
Transfer status is not an independent risk factor for the development of AVN, PTA, or the need for a secondary surgery. However, transferred patients did experience an average delay of 8 h in time to reduction compared to those who presented directly to a trauma center. Of the 27 patients with a reduction delay greater than 12 h, 26 (96%) were transferred.
髋关节原发性脱位是一种高能量损伤，会导致患者出现严重的疾病。及时复位已被证明可改善患者的预后。我们研究的目的是比较直接到一级创伤中心就诊的髋关节原发性脱位患者与从外院转来的患者（OSH）的并发症发生率。我们的假设是，从 OSH 转来的患者复位时间会延迟，随后会出现更高的股骨头坏死（AVN）、创伤后关节炎（PTA）和需要二次手术的发生率。
我们对 2007 年 1 月至 2020 年 12 月期间我们的一级创伤中心的所有髋关节原发性脱位患者进行了回顾性图表审查。最初的查询结果为 628 例患者，在排除了诊断代码不正确或随访时间少于 6 个月的患者后，将结果精减至 90 例。我们的主要结局是发生 AVN、PTA 和需要二次手术。记录了所有纳入患者的受伤至复位的时间。
每延迟一小时复位，发生 AVN 的风险增加 3.4%（p=0.004），发生 PTA 的风险增加 4.3%（p=0.01）。复位延迟每增加一小时，需要二次手术的风险增加 4.6%（p=0.03）。与直接到我们中心就诊的患者相比，转院患者的平均复位时间更高（13.8 小时 vs 5.7 小时）；然而，转院状态并不是这些测量结果的独立危险因素。
转院状态不是发生 AVN、PTA 或需要二次手术的独立危险因素。然而，与直接到创伤中心就诊的患者相比，转院患者的复位时间平均延迟了 8 小时。在复位时间延迟超过 12 小时的 27 例患者中，有 26 例（96%）是转院的。
