Fracture-dislocation of the hip; an end-result study.

Dislocation of the hip is an emergency demanding immediate reduction. Manipulative reduction should take precedence over treatment of all other skeletal injuries and even abdominal injuries. Open reduction of the acetabulum may be delayed, provided the dislocation of the femoral head has been reduced. Postoperative immobilization is necessary only to maintain stability. If fractures are stable, there is no indication for prolonged restriction of weightbearing. Early, active, and vigorous exercise to restore muscle function and to prevent degeneration of the articular cartilage is a major feature of therapy. Early exercise does not tend to promote the deposition of calcium or the development of myositis ossificans. The age of the patient has little influence upon the end result. Avascular necrosis is the result of disruption of the blood supply to the femoral head, and is possibly the result of intracellular molecular changes in the femoral head incidental to force and counterforce imposed at the time of injury. The average rate of the development of avascular necrosis is the same, regardless of the method of treatment. Arthritis develops in direct proportion to the severity of the fracture and the extent of vascular damage. Injuries of the sciatic nerve warrant exploration if their effects persist for two weeks without improvement.