Patterns and short-term treatment outcomes of traumatic hip dislocations in adult patients at Moi Teaching and Referral Hospital, Eldoret

Abstract

Background: Traumatic hip dislocations (THD) accounts for about 5% of traumatic joint dislocations. Due to the inherent stability of the hip joint a lot of force is required to dislocate it. This excessive force often causes associated injuries that may delay the diagnosis and treatment of the hip dislocations, resulting in poor outcomes on long term follow up. At MTRH, there is paucity of information on patterns of traumatic hip dislocations and their treatment outcomes in adult patients. This study therefore seeks to bridge that information gap. Objective: To determine the patterns of traumatic hip dislocations and their short-term treatment outcomes in adult patients at MTRH. Methods: This prospective descriptive study was conducted at MTRH (Accident and Emergency Department, Orthopaedic wards, and Outpatient clinics). Formal approval to conduct the study was provided by IREC and MTRH administration. The study population included adult patients who presented with traumatic hip dislocations. Consecutive sampling was done. An interviewer administered questionnaire was used to collect data. More data was obtained by reviewing the patients’ radiographs and file notes. The patients were then reassessed using a Harris Hip Score three times at an interval of three months. Obtained data was analysed using SPSS version 20, and presented in prose, graphs and frequency tables. Results: A total of 53 patients with traumatic hip dislocations were enrolled in this study. Five of the participants were lost to follow up at various stages of the study. The mean age at the time of dislocation was 36.1±SD 12.7 years (range 19 – 63 years). There were 45 (84.9%) males and 8 (15.1%) females. Thirty-eight (71.7%) of the patients had sustained the dislocations due to road traffic accidents. The other causes of THD were falls from heights (17%) and assault (11.3%). Forty-nine (92.5%) of the patients had posterior THD while 4 patients (7.5%) had anterior dislocations. Associated injuries were present in 29 (54.7%) of the patients, with fractures of the acetabulum accounting for majority of these associated injuries (30.2%). Craniofacial soft tissue injuries accounted for 13.2% of the associated injuries. In 38 (71.7%) of the participants closed reduction was achieved while open reduction was performed in the other 15 (28.3%) patients. Thirty-five (66%) of the dislocations were reduced within 24 hours of injury. At nine months follow up 96% of the patients had good and excellent functional outcomes, while 4% had poor and fair outcomes. Conclusion: Most of the traumatic hip dislocations were due to road traffic accidents. Majority of them were posterior dislocations. Most of the dislocations were treated by closed reduction. Short-term functional outcome at 9 months after injury was satisfactory in majority of patients. Recommendation: Emphasis on road safety to reduce road traffic accidents and consequently numbers of traumatic hip dislocations. More efforts to be put in for timely reductions of THD by creating awareness among healthcare workers in peripheral health facilities.