INJURY CLASSIFICATIONS AND OPERATIVE APPR OACHES IN HIP DISLOCATION AND FRACTURES

During the last few decades, traumatic injuries of the hip joint have significantly increased in number, and traffic accidents have also inc reased. Depending on the speed, direction of the forces and the positi on of the femur at the moment of impact, different patterns of injury occur. Basically, they are classified as hip dislocations, dislocation fractures and acetabular fractures. These injuries have in common a h igh rate of concomitant lesions. Several classification systems have b een developed for these injuries. Commonly, Stewart and Milford's or L evin's classification is used for dislocations and dislocation fractur es. For acetabular fractures, Judet and Letournel's classification and its newer version developed by Helfet (AO classification) are general ly accepted. Fractures of the femoral head, though included in these c lassifications, are typically described by separate classifications li ke the one presented in 1957 by Pipkin. The multitude of injuries occu ring in the hip joint requires vast knowledge of various operative app roaches. No single approach exists that would permit the treatment of all injuries in an ideal fashion. Approaches are either considered lim ited (Kocher-Langenbeck, ilioinguinal ilio-femoral) when they permit a ccess only to a restricted segment of the joint, or extended (extended iliofemoral, Maryland, Ruedi) when they allow all-around visualizatio n of tile hip joint. The choice of the best approach for an individual patient depends on the type of injury and also on patient Variables l ike age, preexisting disease, and concomitant injuries. The decision i s further influenced by the timing of surgery, the kind of fracture st abilization intended and by complications typically seen with certain approaches. The indication for extended procedures is only seen in pat ients with complex injury patterns involving both the anterior and the posterior column or in delayed cases undergoing surgery more than 3 w eeks after trauma. Extended approaches permit excellent visualization of the fracture, but the extent of the soft tissue trauma is reflected in a high rate of postoperative complications. After a phase in which extended procedures were favored, recently a trend towards more limit ed approaches can be recognized because of their lower complication ra te. This is facilitated by modern fracture-reduction methods using ind irect techniques.