Traumatic Dislocation of the Hip with Fracture of the Shaft of the Ipsilateral Femur.

Traumatic dislocation ofthe hip with a fracture ofthe shaft ofthe femur on the same side is such a rare injury that, although there are several reports ofsingle patients, only two surgeons, Dehne and Immermann (1951), have reported treating a number ofpatients. Sir Astley Cooper in I 823 was the first to record the successful treatment of this condition. His patient, a boy of sixteen, had a fracture of the mid-shaft of the femur and a posterior dislocation of the hip. It was thought that the dislocation could not be reduced until the femoral fracture had united, and, five weeks after the injury, the dislocation was reduced in halfan hour using pulley traction. Watson-Jones (1955) has stated recently that the fracture should first be reduced, and immobilised by internal fixation, before the hip is reduced. Henry and Bayumi (1934) reported a patient aged sixty-four whom they first saw three weeks after injury and who had a fracture of the shaft of the femur and a dislocation of the hip: an attempt at closed reduction of the latter was unsuccessful and open reduction was performed. They found in the literature individual reports of fifteen other patients of whom seven had a successful closed reduction ; one had an open reduction ; in seven the dislocation was not reduced and in one reduction was doubtful. The youngest patient was eight and the eldest sixty-four years old. Dehne and Immermann (1951) treated seven patients with this combined injury and gathered information on nine others treated by various surgeons. In only seven of these sixteen patients was the dislocation diagnosed soon after the injury. Closed reduction of the dislocation and open reduction of the fracture was successful in three, manipulation was successful in one with the help of skeletal traction through the tibial tubercle, two had open reduction of the dislocation and of the fracture, and the remaining patient had an open reduction ofthe fracture, but closed reduction ofthe dislocation failed (no further information was given). In the other nine patients the dislocation was recognised late. Open reduction of the dislocation was done in six, five of whom were left with marked stiffness in the hip; a sixth was treated after reduction by skeletal traction and was not allowed to bear weight for nearly three years and gained good hip movements; three patients had an arthrodesis of the hip, which was unsound in one. All these patients were adults, the youngest being twenty-one and the eldest forty-three years old. Ingram and Turner (1954) reported a youth of seventeen who had bilateral dislocation of the hips with bilateral fractures of the femoral shafts, the reduction being done by skeletal traction through the greater trochanters. Wiltberger, Mitchell and Hedrick (1948) reported a man aged thirty-five who had a posterior dislocation of the hip and a fracture of the upper third of the shaft of the femur. They reduced the hip only after fixing a lever to the greater trochanter by two pins and applying skeletal traction through the tibial tubercle.