A rapid and accurate reduction is important for hip dislocated patients to avoid various potential complications, including avascular necrosis of the femoral head. We analyzed hip dislocation cases, ones that particularly failed during the primary reduction trial.

Eighty-seven patients with hip dislocation, who visited the emergency department between January 2007 and September 2015, were retrospectively analyzed. Of them, 68 patients were successfully treated in the first closed reduction trial, and the remaining 19 patients were unsuccessful. Of the 19 unsuccessful first trial, 12 patients were successfully treated in the second closed reduction; however, in the remaining 7 patients, open reduction was performed in the operation room with general anesthesia. Every closed reduction was practiced by at least 2 orthopedic doctors, and open reduction was performed by a single senior author.

The rate of first reduction failure was higher, with statistical significance, in patients aged under 50 years, male gender, and those with combined around hip fractures, including femoral head and acetabular fracture (p<0.05). In particular, the presence of impacted fracture fragment in the hip joint and large size of the impacted fracture fragment was highly related to the failure of second closed reduction trial requiring open reduction. Conversely, the method of reduction, Thompson-Epstein classification, Pipkin classification were not related to the failure of closed reduction statistically (p>0.05).

To evaluate the patients with hip dislocation, realizing the type of dislocation, presence of accompanied fracture, location and size of fracture fragment, age, as well as gender of patients is important. If the fracture fragment is impacted in the hip joint and the size of the fragment is large, then the operative treatment is considered, rather than the repetitive trial of closed reduction by constraint.