1、Floating hip injuryFloating hip injuryDepartment of Orthopaedics，Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine，ShanghaiA floating hip is defined as a fracture of the pelvis or acetabulum with a concomitant femur fractureThis injuries is uncommon and estimated to o
2、ccur once in every 10 000 fractures Anterior and posterior dislocations of the ipsilateral hip can be associated with this injury Definition mechanismmechanism ofof injuryinjury dashboard injury-causing a posterior wall or transverse with posterior wall fracture of the acetabulum central type injury
3、 which includes a central type acetabular fracture and an ipsilateral proximal femoral fracture.Liebergall,M.,et al，The floating hip injury:patterns of injury.Injury,Int.J.Care Injured 33(2002)717722mechanism of injuryassociated injury associated injury hemorrhagic shock Organ damage:liver,spleen,ki
4、dney rupture;bladder,ureter injury,traumatic diaphragmatic hernia Peripheral nerve and artery injury Multiple fracturesSpinal fracturesclassification of Mullerclassification of Muller Floating hip types were described according to the classification of Muller,in which:type A includes an acetabular f
5、racture type B includes a pelvic ring fracture type C includes both acetabular and pelvic ring fracture components.Mller EJ,Siebenrock K,Ekkernkamp A,Ganz R,Muhr G.Ipsilateral fractures of the pelvis and the femur-floating hip?A retrospective analysis of 42 cases.Arch Orthop Trauma Surg.1999;119(3-4
6、):179-82.classification of Mullerclassification of Muller type A fractureclassification of Mullerclassification of Muller type B fracture classification of Mullerclassification of Mullertype B fractureclassification of Mullerclassification of Mullertype B fractureclassification of Mullerclassificati
7、on of Mullertype C fractureBasic treatmentFirst aid principles(Damage Control Theory)First aid principles(Damage Control Theory)：rescueing hemorrhagic shock firstlyDeal with other associated injuries on the basis of the anti-shockAdopting external fixation promptly to treat serious bleeding patients
8、Last treat fractures in stable conditionTreatment principles：A definitive surgical stabilisation of the femur was carried out as a primary procedure and usually took precedence over fixation of the pelvic or acetabular fractures.Fracture treatmentLiebergall,M.,et al.,The floating hip.Ipsilateral pel
9、vic and femoral fractures.J Bone Joint Surg Br,1992.74(1):p.93-100.To fix femur fracturesThe fixed type of proximal femur fracture Femoral neck fractures:Closed reduction and cannulated screw fixationTotal hip arthroplastyIntertrochanteric fracture:PFN（PFNA）Gamma nail DHSPCCPTo fix pelvic fracturesa
10、nteriorpelvic ring fractures：Pubic symphysis platePercutaneous screwSacroiliac joint dislocation(fracture)：Percutaneous screwAnterior incision and plate fixation External fixationTo fix acetabular fracturesTiming of surgery 21 daySelecting approach according to the fracture site:KocherLangenbeck app
11、roach:posterior fracture(posterior column,posterior wall)Ilioinguinal approach:anterior fracture(anterior column,anterior wall)Extend Iliofemoral approach:both anterior and posterior were fractures(double column,T-shaped)fixation with 3.5mm reconstruction platePostoperative treatment Routine using a
12、ntibiotics for 3-5 days Prevention of venous thromboembolism Prevention of heterotopic ossification 3 days after the surgery to perform CPM functional exercise One week after the surgery not weight-bearing walking with crutches After 8 weeks week after the surgery,gradual weight-bearing walkingCommo
13、n complications Deep vein thrombosis（DVT）and vascularinjuries floating hips with associated vascular injuries have a very poor outcome and frequently results in an above-knee amputation despite immediate vascular repair Sciatic nerve injurySciatic nerve palsy occurs in 2635%of floating hip injuries,
14、an incidence greater than with acetabular fractures alone Heterotopic ossification of hip joint Traumatic arthritis of the hip joint Femoral shorteningBurd,T.A.,M.S.Hughes and J.O.Anglen,The floating hip:complications and outcomes.J Trauma,2008.64(2):p.442-8.Case1Falls injury,double column of acetab
15、ular and pelvic ring,and the left femur fracture,belong to C type Transferring to our hospital after 10 days of ORIFCase1We perform a ORIF for himCase2posterior wall of acetabular and left femoral shaft fracture,belong to A typeto keep traction after ORIF of ferum Falls injury,pelvic fracture+right
16、femoral neck fracture,belong to B type.Case3After percutaneous cannulated screws fixed femoral neck fracture,pelvic fractures treated conservatively.Case3Traffic accident,Pelvic fractures+left femoral shaft fracture,belong to B type.Case4Pubic bone fracture fixed with plate fixation,and femoral shaf
17、t fractures fixed with intramedullary nailing.Case4dashboard injury,transverse acetabular and left femoral shaft fracture,belong to A typeCase5Pre-operative X-rayCase5Preoperative 3D-CTPost-operative X-rayTraffic accident,transverse fractures of acetabular,and comminuted fracture of left femoral hea
18、d,neck and trochanter,belong to A typeCase6Preoperative CTPreoperative 3D-CTFirstly,to fix proximal femoral fractures with DHS,then fix acetabular fractureTraffic accident,transverse fracture of posterior wall in the right acetabular,pelvic ring and comminuted fracture of the right femoral head,belo
19、ng to C typeCase7Preoperative CTPreoperative 3D-CTAn open reduction and internal fixation and a total hip arthroplasty were performed for this patientCase 8Fracture of double column of acetabular,femur,and tibia Fracture of double column of acetabular,femur,and tibia in the right leg,combined commin
20、uted fracture of right in the right leg,combined comminuted fracture of right radius,belong to A type.radius,belong to A type.Preoperative 3D-CTPreoperative x-ray and CTPost-operative x-ray Falls injury,fracture of two columns of acetabulum,pelvic ring and left femoral neck,belong to C3 typeCase 8Po
21、st-operative X-rayCase 8Ipsilateral Floating Hip and Floating Ipsilateral Floating Hip and Floating KneeKneeCase 9Undisplaced posterior coloumn fracture seen on CT scaninterlocking nail for femur and tibiaConcomitant ipsilateral floating hip Concomitant ipsilateral floating hip and floating knee inj
22、uriesand floating knee injuriesCase 10Concomitant ipsilateral floating hip and floating knee injuriesCase 10Concomitant ipsilateral floating hip and floating knee injuriesCase 10Case 11ipsilateral floating hip and kneeipsilateral floating hip and kneewith concomitant arterial injurywith concomitant
23、arterial injuryCase 12ipsilateral floating hip and kneewith concomitant arterial injuryCase 12ipsilateral floating hip and kneeipsilateral floating hip and kneewith concomitant arterial injurywith concomitant arterial injuryCase 12Postoperative and follow-up X-Postoperative and follow-up X-rayrayCas
24、e 12Summary Summary Most injury floating hip injury were high-energy,combined more serious associated injuries,the treatment should be to save lives firstly,and prioritize life-threatening injuries,finally,fixed fractures after vital signs were stable.The treatment sequence is:the femur,pelvis and a
25、cetabulum;According to damage control theory,based on the specific circumstances of each patients,to develop surgical planning and treatment programs;did not pursue all parts of the pelvic fractures are treated surgically.With a long operation time,much bleeding,reduction difficult,the femoral fracture should be surgically stabilised urgently,while,a later(35 days)reduction and fixation is recommended for the acetabular fracture.Surgery timing should not exceed 3W,otherwise to reduce fracture of the pelvis and acetabulum difficultly.
