Chronic traumatic hip dislocation: the Cambodian experience

Background: Evidence is conflicting on the best way to manage patients presenting late following a traumatic hip dislocation. Objective: Report our experience of managing patients presenting late following a traumatic dislocation of the hip. Patients and method: A retrospective analysis of patients presenting late with a traumatic hip dislocation to the Children’s Surgical Centre between January 2002 and September 2010 was performed. Thirty-three eligible patients were identified. Twenty-eight patients underwent femoral head conserving treatments. In four patients, total or hemi-arthroplasty was performed, and one patient underwent hip arthrodesis. Results: Eleven patients had documentation of the absence or presence of evidence of avascular necrosis (AVN). Of these, three patients had clinical or radiological signs of AVN. Nineteen patients returned for follow-up and five had an excellent outcome, seven had a good outcome, four had a fair outcome, and one had a poor outcome. Two patients did not have enough clinical information in their medical records to have their outcome classified. A better outcome at follow-up was associated with a shorter mean average time from trauma and the use of femoral head conserving operative interventions. Conclusion: This study supports the theory that patients presenting late following a traumatic hip dislocation can achieve satisfactory outcomes if managed with femoral head conserving strategies, as the femoral head retains its vascular supply in the majority of cases. We also propose that consideration be given to drilling the femoral head during open reduction to ascertain the integrity of its blood supply.