gms | German Medical Science

Objectives: The floating hip injury is a rare and complex fracture that involves the pelvis and the ipsilateral femur, and is therefore challenging to treat. Data and studies on this subject are still rare. The optimal strategy for surgical care, and thus the resulting treatment quality, is still under discussion; a femur first strategy is the frequently preferred treatment.

Methods: Patients with a pelvic fracture who underwent treatment at the level I Trauma center of the University of Tübingen between 2003 and 2017 were identified retrospectively. Among them, patients with an additional ipsilateral femur fracture were identified. We compared the treatment quality of pelvic fractures between floating hip and non-floating hip pelvic fractures.

Results: Proximal femoral fractures usually do not coincide with acetabular (n=1) but rather with collateral pelvic ring fractures (n=16). No comparable difference of that sort can be found in femoral shaft and distal femoral fractures.

Floating hip fractures often occure in younger polytraumatized male patients with a significantly higher ISS than in non-floating hip pelvic fractures (20.2±9.8 vs. 14.8±11.4; p<0.001). Pelvic fractures as part of floating hip injuries are more often operated on (62.8% vs. 39.1%; p=0.003) and the clinical course is significantly prolonged (27.8±19.3 vs. 19.9±23.1 days; p<0.001). The treatment quality however, exemplarily assessed by morbidity (18.6% vs 14.6%; p=0.610) and mortality (7.0% vs. 2.6%; p=0.108) does not show any differences.

Conclusion: Thus, the injury severity and complexity are significantly higher in floating hip fractures, yet without affecting the resulting treatment quality. A femur first treatment strategy, as part of damage control surgery, is prioritized. Our treatment algorithms for emergency treatment and definitive care is proposed in a flowchart (Figure 1).