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PubMedDate not supplied

Mechanics of the treatment of hip injuries.

When treated operatively, mechanical problems associated with intertrochanteric hip fracture include malunion and nonunion. Their frequency and severity are directly related to the mechanical effectiveness of internal fixation, which is determined by 5 independent variables: bone quality, fragment geometry, reduction, implant, and implant placement. While all 5 variables are of importance, bone quality and fragment geometry are the product of the patient and the trauma and cannot be significantly modified by the treating surgeon. Reduction, implant placement, and implant selection are the variables which the surgeon can manipulate. While all 3 are important, implant selection and implant placement are of relatively greater importance than reduction. Implant placement in the biomechanically ideal position for the individual patient is probably the single most important of the 5 variables.

Biomechanical Phenomena↗
PubMed1977

[Diagnosis and treatment of postoperative infections following hip injuries].

The authors studied the diagnosis and treatment of posttraumatic infections of the hip joint, based on their own material. In case of latent infection the increased sedimentation rate and taking of comparative X-ray films are held important, that shows a narrowing and disappearance of the sclerosed edge of the acetabulum. Following dislocation of the hip joint ankylosis may be attained, but after fractures of the proximal and of the femur the infection cannot be cured, unless the nail and the head of the femur are removed.

Adult↗
PubMed2003

Ex-professional association footballers have an increased prevalence of osteoarthritis of the hip compared with age matched controls despite not having sustained notable hip injuries.

OBJECTIVE: To compare the prevalence of self reported, physician diagnosed osteoarthritis (OA) of the hip in ex-professional footballers with that in age matched controls in the general public. METHOD: A questionnaire was sent to the 92 football league and premiership managers to assess the prevalence of OA of various joints. The prevalence of OA of the hip in those managers that were ex-professional footballers was assessed. Radiographic controls were obtained and used to assess the prevalence of OA of the hip in the general population. The results of the two groups were compared statistically using chi(2) tabulation. RESULTS: Seventy four (80%) of the managers responded to the questionnaire. Nine of the 68 ex-professional footballers who replied had OA of the hip, and six of these had undergone a total of eight total hip replacements. Of the 18 managers who did not respond, 12 were known to be ex-professionals. In the control group of 136, two had OA of the hip. The two groups differed significantly (p<0.001). The odds ratio for OA of the hip was 10.2 (95% confidence interval 2.1 to 48.8). CONCLUSION: The ex-professional footballers had a significantly higher prevalence of OA of the hip than an age matched group of radiographic controls.

Adult↗
PubMed1989

Biomechanical aspects of pelvic and hip injuries in road traffic accidents.

The mechanism of pelvic fractures has been well documented from radiographs but little is known of the forces required to produce these injuries. We examined 40 cases of pelvic injury sustained in road traffic accidents where the direction of impact and the velocity differential was known. In frontal impacts, indirect shear injuries of the pelvis were prominent, while in side impacts, lateral compressive injuries occurred. With increasing velocity differentials and vehicle deformation and intrusion, more severe pelvic injury occurred, often in association with significant head, chest, and lower limb injuries. Side impacts were noted to produce more severe injuries at lower velocity differentials when compared with frontal crashes.

Accidents, Traffic↗
PubMed1969

Injuries to hip joint in car occupants.

Four varieties of fracture, of dislocation, or of fracture dislocation of the hip are described that occur in car occupants after road accidents. It is suggested that, whereas most hip injuries to car occupants are produced by application of force to the knee, one important variety (central fracture dislocation) is the result of the direct application of force to the great trochanter. Central fracture dislocations might be prevented, or their severity minimized, by strengthening the sides of cars and of car doors and by improving the energy absorption characteristics of the facia panel.

Accidents, Traffic↗
PubMed2004

Injuries to the hip joint in frontal motor-vehicle crashes: biomechanical and real-world perspectives.

Hip fractures and dislocations in frontal crashes are of substantial concern to clinicians and automotive safety engineers because of the frequency at which hip injuries occur and the associated potential for long-term disability. Impacts to the flexed knees of unembalmed cadavers under loading conditions similar to those that occur in frontal crashes of newer-model vehicles indicate that the hip is the weakest part of the knee-thigh-hip complex and that hip injury tolerance is reduced by hip flexion and adduction from a typical driving posture. These results are being used to develop new knee-thigh-hip injury assessment criteria for use in anthropomorphic test devices (crash test dummies).

Accidents, Traffic↗
PubMed1998

Midshaft femoral fracture, concomitant ipsilateral hip joint injury, and disruption of the knee extensor mechanism: a unique triad of dashboard injury.

Our experience with 10 patients who suffered midshaft fractures of the femur and injuries to their ipsilateral hips has resulted in a treatment protocol that we believe can avoid unnecessary complications. The surgical protocol is a three-stage procedure based on (1) intramedullary nailing of the femur with interlocking for preserving the anatomic length and rotation of the femur; (2) treatment of the hip joint injury by means of open reduction and internal fixation of the acetabular fracture and/or reduction and fixation of the fractured femoral neck; and (3) repair of the extensor mechanism. Eight patients received this treatment and had fast recoveries. Union of the femoral fracture and full range of motion of the knee joint were observed within 3 months. In contrast, two patients who had received different surgical treatment had incomplete functional recoveries. This study offers a treatment protocol for ipsilateral disruption of the extensor mechanism, hip joint injury, and midshaft fracture of the femur in the multiply injured patient that can achieve full recovery with no complications. This relatively rare combination of injuries is definitely worthy of special attention.

Accidents, Traffic↗
PubMed2005

Hamstring injuries of the hip.

Hamstring injuries can be classified with regard to the site of involvement. Traumatic disorders at the proximal bone-tendon origin are best defined as avulsion injuries, such as ischial tuberosity fractures and hamstring tendon tears. Musculotendinous lesions include muscle strains and muscle contusions. Most hamstring injuries occur after in-direct trauma from excessive stretching or forceful contraction, leading to avulsion injuries or muscle strains and tears. Insufficient warm-up, lack of flexibility, inadequate muscle strength and endurance, or abnormal contraction and running may predispose to such injuries. In the event of blunt direct trauma, a muscle contusion, intramuscular hematoma, myositis ossificans, or compartment syndrome may develop.

Athletic Injuries↗
PubMed2002

The tolerance of the human hip to dynamic knee loading.

Based on an analysis of the National Automotive Sampling System (NASS) database from calendar years 1995-2000, over 30,000 fractures and dislocations of the knee-thigh-hip (KTH) complex occur in frontal motor-vehicle crashes each year in the United States. This analysis also shows that the risk of hip injury is generally higher than the risks of knee and thigh injuries in frontal crashes, that hip injuries are occurring to adult occupants of all ages, and that most hip injuries occur at crash severities that are equal to, or less than, those used in FMVSS 208 and NCAP testing. Because previous biomechanical research produced mostly knee or distal femur injuries, and because knee and femur injuries were frequently documented in early crash investigation data, the femur has traditionally been viewed as the weakest part of the KTH complex. However, the relative risk of hip injuries to the risks of knee and thigh injuries in frontal crashes of late-model vehicles suggests that this may not be the case. This study investigated the frontal-impact fracture tolerance of the hip in nineteen tests performed on the KTH complexes from sixteen unembalmed human cadavers. In each test, the pelvis was rigidly fixed by gripping the iliac wings with the thigh-to-pelvis angle set to correspond to a standard automotive-seated posture. A dynamic load was applied to the knee along the axis of the femur at loading rates that are representative of knee-to-knee bolster impacts in frontal crashes. Rigidly fixing the pelvis minimizes inertial effects along the KTH complex, which results in similar force levels along the KTH complex. Consequently, in these tests, the weakest part of the KTH complex failed first. All seventeen fixed pelvis tests that produced usable data resulted in acetabular fractures at an average applied force of 5.70 kN (sd = 1.38 kN). The lack of injuries to the femoral shaft and distal femur in these tests indicates that the tolerance of the hip is less than that of the femur under frontal-impact loading. To further explore the tolerance of the femur relative to the hip, thirteen uninjured knee/femur specimens from seven cadavers previously used in hip tolerance tests were dynamically loaded. In these tests, the head of the femur was supported in a fixed "acetabular cup" to minimize inertial effects, and load was applied at the knee along the axis of the femur. All of these tests resulted in femoral neck fractures. Two tests also resulted in fractures to the femoral shaft. The average tolerance of the femoral neck from these tests is 7.59 kN (sd = 1.58 kN), which is significantly higher (p < 0.05) than the tolerance of the acetabulum. These results suggest that the mid and distal portions of the femur have a higher tolerance under these loading conditions than the pelvic and femoral portions of the hip.

Journal Article↗