Stephan Regenbogen

Background: Traumatic hip dislocations are rare but serious injuries, potentially affecting patients’ quality of life and mobility. Given the limited understanding of prognostic factors, this study aimed to identify predictors of long-term clinical outcomes. Materials and methods: Injury characteristics and computed tomography (CT) of patients following traumatic hip dislocation from two level I trauma centers from 2009 to 2015 were analyzed. At follow-up, patients were evaluated for avascular necrosis (AVN), post-traumatic osteoarthritis (PTOA), secondary surgery, complications, and return to sports. Patient-reported outcome measures (PROMs), including Tegner Activity Scale (TAS) and modified Harris Hip Score (mHHS), were evaluated. Results: 38 patients with traumatic hip dislocation were finally included. Concomitant posterior acetabular wall fractures and femoral head fractures (Pipkin type I to IV) were observed in 34 cases (87%). 18 patients (mean age 38.3 ± 17.2 years) completed the follow-up (mean follow-up 12.25 ± 1.03 years). 6 patients (33%) developed PTOA, 2 patients (11%) AVN, and 3 patients (17%) required total hip arthroplasty. Decreased TAS was associated with concomitant fractures ( p = 0.02). 10 patients (56%) did not return to their pre-injury sports level and 7 patients (39%) reported sexual dysfunction. PROMs and return to sports were significantly worse in patients with PTOA or residual sciatic nerve injury ( p < 0.05). Conclusions: Patients after traumatic hip dislocation are at high risk for PTOA or AVN, especially with concomitant acetabular or femoral head fractures, resulting in significant long-term limitations in daily activities, sports, and sexual function. Recognition of concomitant fractures is a critical prognostic factor in assessing long-term outcomes.

Purpose: Traumatic anterior hip dislocation is a severe but poorly studied injury. This study aimed to analyze characteristics, risk factors and prognostic factors regarding long-term morbidity and outcomes in patients who had sustained traumatic anterior hip dislocation. Methods: Demographics, injury mechanism, and treatment-related characteristics of patients with anterior hip dislocations at three level-one trauma centers from 2009–2023 were analyzed. Acetabular and femoral morphology were assessed using CT scans to identify anatomical risk factors. Incidence of avascular necrosis (AVN), post-traumatic osteoarthritis (PTOA), further complications, return to work and sports, and patient-reported outcomes (PROMs), including Tegner Activity Scale (TAS) and modified Harris Hip Score (mHHS) were recorded at the follow-up. Results: Out of 196 patients with traumatic hip dislocations, 19 anterior dislocations (12 iliac anterosuperior and 7 obturator) were identified. Ipsilateral knee injuries occurred in 36.8%, and 73.7% had concomitant femoral head or acetabular rim fractures. Obturator dislocations were commonly simple dislocations, while iliac dislocations involved more complex associated fractures often requiring surgery. Acetabular anteversion and cam-type femoroacetabular impingement (FAI) were identified as risk factors. Twelve patients (63%) were available for follow-up (mean 8.33 ± 5.05 years). The majority demonstrated good to excellent mHHS (mean 86.9), and minimal TAS decrease (5.33 to 4.67). AVN was not observed, and only one patient required hip arthroplasty following PTOA. Conclusion: Anterior hip dislocations commonly result from high-energy “dashboard" injuries, with acetabular anteversion and cam-type FAI morphology being contributing risk factors. Long-term functional outcomes were favorable, with low rates of avascular necrosis or osteoarthritis, independent of type and complexity of the dislocation.

Background: There has been an increasing number of fragility fractures of the sacrum in the recent decade. With rates of up to 28%, the complication rates after surgical treatment are still at an unacceptably high level, and new treatment strategies are urgently needed. Therefore, the purpose of this study was to evaluate the potential of 3D-navigated trans-sacral bar osteosynthesis in the surgical treatment of fragility fractures of the sacrum. Methods: Retrospectively, from 2017 to 2023, all cases with confirmed fragility fractures of the sacrum in patients > 65 years of age that were surgically treated with navigated 3D-navigated trans-sacral bar osteosynthesis were included, and epidemiological data and the course of treatment analyzed in comparison to a matched control group. Results: Finally, 21 patients (18 women and 3 men) were included in this study. The average age of the patients was 82.6 (SD 6.3) in the intervention group and 79.4 (SD 6.7) in the control group. There were postoperatively detected complications in two cases (18%) in the intervention group and in four cases (40%, p = 0.362) in the control group. The postoperative in-hospital stay was 10 days (SD 3.8) vs. 11.4 days (SD 3.8) in the control. None of the patients in the intervention group and two in the control group needed revision surgery. Conclusions: Overall, 3D-navigated trans-sacral bar osteosynthesis seems to be a promising technique, enabling an accurate implant positioning while offering a low complication rate with an excellent short-term outcome in elderly patients with fragility fractures of the sacrum.

Purpose: Although treatment strategies of knee joint dislocations have evolved, there is still no consensus on the best method and timing. New therapeutic concepts suggest that early one-stage treatment, including suturing and bracing of the cruciate ligaments in acute knee joint dislocation, are leading to improved functional results. This study aimed to evaluate the midterm functional outcome following traumatic knee joint dislocation and to determine whether the outcome is influenced by the surgical management, patient habitus or concomitant injuries. Methods: In this retrospective single center study, 38 patients with acute Schenck type II to IV knee dislocations were treated over an eight-year period in a level I trauma center. At follow-up, various clinical scores, such as the International Knee Documentation Committee (IKDC) Score, Lysholm Score, and Tegner Activity Scale (TAS), and individual questions about rehabilitation and activity levels of 38 patients were evaluated. Results: Mean follow-up was 5.5 ± 2.7 years. The mean IKDC Score was 65.6 ± 15.7 points, the average Lysholm Score was 70.5 ± 16.4 points and the median TAS was 4 (0–7), resulting in a loss of activity of 2 (range 0–6) points. There was no significant difference between a one-stage treatment compared to a two-stage approach. Ligament reconstruction of the ACL in a two-stage approach was required in only 33.3%. Further operations (early and late) were performed in 37% of cases. Being overweight was associated with more complications and worse outcomes, and external fixation with arthrofibrosis. Conclusions: Knee dislocation is a severe trauma that often leads to a prolonged loss of function and increased knee pain over years, affecting the patient’s activity. Clinical outcome is influenced significantly by concomitant injuries. Severe cases with initial external fixation are associated with a higher risk of knee stiffness and should be considered during rehabilitation. Obese patients present a challenge due to higher complication rates and lower postoperative knee function. Level of evidence: Retrospective single center study, level III.