Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries
Abstract
:1. Introduction
2. Patients and Methods
2.1. TraumaRegister DGU® and Data Acquisition
2.2. Inclusion and Exclusion Criteria
2.3. Definitions
2.3.1. Mechanisms of Injury
2.3.2. Injury Severity
2.3.3. Identification of Traumatic Hip Dislocation and Ischial Nerve Compromise
3. Statistical Analysis
4. Results
4.1. Prevalence
4.2. Demographic Data and Mechanisms of Injury
4.3. Injury Severity and Patterns
4.4. Hospital Stay, Delayed Diagnosis, and Outcome Data
4.5. Logistic Regression Analysis
5. Discussion
5.1. Prevalence
5.2. Delayed Diagnosis
5.3. Demographic Data
5.4. Mechanisms of Injury
5.5. Injury Severity and Patterns and Concomitant Injuries
5.6. Limitations and Strengths
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Control Group n = 166,420 | Hip Dislocation n = 1349 | Total | |
---|---|---|---|
Motor vehicle accident % (n) | 25.1% (41,702) | 49.9% (673) | 25.3% (42,375) |
Motorcycle accident % (n) | 15.2% (25,283) | 18.0% (243) | 15,2% (25,526) |
Bicycle accident % (n) | 8.3% (13,883) | 2.9% (39) | 8.3% (13,922) |
Pedestrian struck % (n) | 7.4% (12,251) | 5.6% (75) | 7.3% (12,326) |
High fall ≥3m % (n) | 17.7% (29,392) | 11.5% (155) | 17.6% (29,547) |
Low fall <3m % (n) | 16.1% (26,784) | 4.2% (56) | 16.0% (26,840) |
Traffic-related (all) % (n) | 57.2% (95,137) | 78.0% (1349) | 57.3% (96,189) |
Suicide attempt % (n) | 4.9% (8142) | 6.0% (80) | 4.9% (8222) |
Other % (n) | 10.3% (17,125) | 8.0% (108) | 10.3% (17,233) |
Control Group | Hip Dislocation | Total | |
---|---|---|---|
Head injury (AIS ≥ 2) | 42.3% (71,669) | 31.7% (435) | 42.2% (72,104) |
Facial injury (AIS ≥ 2) | 14.3% (24,215) | 11.4% (156) | 14.3% (24,371) |
Neck injury (AIS ≥ 2) | 1.2% (2108) | 1.2% (16) | 1.2% (2124) |
Chest injury (AIS ≥ 2) | 61.9% (104,898) | 64.6% (886) | 61.9% (105,784) |
Abdominal injury (AIS ≥ 2) | 20.5% (34,720) | 26.8% (368) | 20.5% (35,088) |
Spinal injury (AIS ≥ 2) | 34.0% (57,688) | 30.3% (415) | 34.0% (58,103) |
Extremity injury (AIS ≥ 3) | 34.7% (58,804) | 53.9% (739) | 34.8% (59,543) |
UE injury (AIS ≥ 2) | 37.5% (63,638) | 35.2% (482) | 37.5% (64,120) |
LE injury (AIS ≥ 2) | 32.9% (55,866) | 100% (1371) | 33.5% (57,237) |
Pelvic injury (AIS ≥ 2) | 21.1% (35,828) | 63.3% (872) | 21.5% (36,700) |
Acetabular fracture % (n) | 4.4% (7407) | 48.7% (667) | 4.7% (8074) |
Femur fracture % (n) | 16.4% (27,783) | 30.5% (418) | 16.5% (28,201) |
Patella fracture % (n) | 1.9% (3217) | 5.8% (80) | 1.9% (3297) |
Ischial nerve injury % (n) | 0.2% (280) | 3.8% (52) | 0.2% (332) |
Aortic injury % (n) | 0.9% (1588) | 2.1% (29) | 0.9% (1617) |
Control Group | Hip Dislocation | |
---|---|---|
Male sex % (n) | 71.5% (121,053) | 79.5% (1087) |
Mean age (SD), years | 49 (22) | 43 (19) |
ISS: mean (SD), points | 21.7 (12) | 22.4 (12) |
New ISS: mean (SD), points | 26.2 (14) | 26.7 (13) |
Level 1 center admission % (n) | 66.8% (113,218) | 66.5% (912) |
Level 2 center admission % (n) | 24.9% (42,289) | 26.6% (365) |
Level 3 center admission % (n) | 8.3% (14,056) | 6.9% (94) |
ICU treatment % (n) | 88.2% (149,471) | 93.1% (1277) |
ICU LOS days † | 7.5/3 (11) | 9.1/4 (13) |
Ventilator, mean days (SD) | 3.7 (9) | 4.6 (9) |
Hospital LOS: days † | 20/14 (21) | 27/22 (24) |
Delayed identification β | NA | 1.1% (7) |
Surgery for dislocated hip % (n) | NA | 70.9% (518) |
Discharged fully recovered % (n) | 56.3% (92,186) | 48.2% (639) |
Discharged with minor impairment % (n) | 23.6% (38,560) | 33.5% (444) |
Discharged with severe impairment % (n) | 7.7% (12,540) | 9.0% (119) |
Discharged with PVS | 1.4% (2229) | 1.2% (16) |
Predicted mortality (RISC II) | 10.8% | 8.7% |
Observed mortality % (n) | 10.7% (18,216) | 7.8% (107) |
Mean treatment costs (Euro) | 18,600 | 24,659 |
Risk Factors | Odds Ratio (OR) | 95% Confidence Interval (CI) | p-Value |
---|---|---|---|
Injury mechanism | |||
Motor vehicle accident | 2.98 | 2.57–3.45 | <0.001 |
Motorcycle accident | 1.99 | 1.66–2.39 | <0.001 |
Pedestrian struck | 1.22 | 0.94–1.59 | 0.130 |
Bicycle accident | 0.80 | 0.57–1.12 | 0.184 |
Suicide attempt | 1.36 | 1.06–1.75 | 0.016 |
Concomitant injuries | |||
Acetabular fracture | 10.85 | 9.21–12.76 | <0.001 |
Ischial nerve injury | 5.40 | 3.83–7.61 | <0.001 |
Pelvic fracture | 1.82 | 1.54–2.16 | <0.001 |
Femur fracture | 1.50 | 1.32–1.70 | <0.001 |
Patella fracture | 1.46 | 1.13–1.88 | 0.003 |
Injury of the aorta | 1.41 | 0.95–2.08 | 0.090 |
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Weber, C.D.; Lefering, R.; Sellei, R.M.; Horst, K.; Migliorini, F.; Hildebrand, F.; TraumaRegister DGU. Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries. J. Clin. Med. 2022, 11, 472. https://doi.org/10.3390/jcm11030472
Weber CD, Lefering R, Sellei RM, Horst K, Migliorini F, Hildebrand F, TraumaRegister DGU. Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries. Journal of Clinical Medicine. 2022; 11(3):472. https://doi.org/10.3390/jcm11030472
Chicago/Turabian StyleWeber, Christian D., Rolf Lefering, Richard M. Sellei, Klemens Horst, Filippo Migliorini, Frank Hildebrand, and TraumaRegister DGU. 2022. "Traumatic Hip Dislocations in Major Trauma Patients: Epidemiology, Injury Mechanisms, and Concomitant Injuries" Journal of Clinical Medicine 11, no. 3: 472. https://doi.org/10.3390/jcm11030472