Functional outcome and health-related quality of life following ipsilateral femoral and acetabular fractures: a retrospective analysis

Abstract

Introduction: The combination of ipsilateral femoral and acetabular fractures is known in the literature as the "Floating hip injury". The primary aim of this study is to assess both generic and specific patient-reported outcomes and the factors affecting the quality of life in patients sustaining this injury, while the secondary aim was to assess the injury patterns and the associated complications.

Methods: A retrospective study including 27 patients according to specific inclusion and exclusion criteria. EQ5D5L and Oxford hip score (OHS) were used. The mean age was 28 years (±10.1 SD) and 21 patients (77.8%) were males. The mean follow-up was 7 years (± 3.1 years SD).

Results: Median OHS was 46.5 (IQR: 31.5-48). The median EQ5D score was 0.919 (95% CI: 0.601-1). The mean EQ5D index value was 0.679 ± 0.442 (95% CI: 0.492-0.865). In this young cohort of patients, this drop in the mean EQ5D index value has led to a loss of a mean of 2.2 Quality-adjusted Life Years (QALYs). Through multivariate analysis, we found that the quality of life was mainly affected by the occurrence of end-stage arthritis, the presence of non-recovered traumatic sciatic nerve injury, and the occurrence of infection.

Conclusions: Our findings show that the quality of life of those patients was significantly affected. These findings can be beneficial in counselling patients sustaining this complex injury and could be helpful in the discussion of the prognosis and in planning postoperative rehabilitation and support.

Keywords: Floating hip; Functional outcome; Ipsilateral femoral and acetabular fractures; Quality of life.

Figure 1

Case example showing ipsilateral acetabular fracture and proximal femoral fracture. Top row: Preoperative X-ray and 3D- reconstruction CT scan. Bottom row: X-rays at 7 years postoperative.

Figure 2

Correlation between Oxford hip score (OHS) and the value set of the EQ5D5L in 24 patients with ipsilateral femur and acetabular fracture.

Figure 3

Top row: Preoperative X-rays for an ipsilateral acetabular and segmental femoral fracture, treated with fixation of acetabulum through posterior approach, and femoral nailing followed by plate augmentation for nonunion of midshaft fracture. Bottom row: 6 year follow-up X-rays.