Abstract
Introduction The “floating hip” is a rare and complex fracture involving the pelvis and the ipsilateral femur and is therefore difficult to treat. Data and studies on this topic are
still scarce. The optimal strategy for surgical treatment and thus the resulting quality of treatment are still being debated; a femur-first strategy is often the preferred treatment.
Methods Retrospectively, patients with a pelvic fracture treated at the Level I Trauma Centre of the University of Tübingen between 2003 and 2017 were identified. Patients with an
additional ipsilateral femur fracture were identified in this collective. We compared the quality of treatment of pelvic fractures between floating and non-floating hip injuries.
Results Proximal femur fractures were more common with pelvic ring fractures (n = 16) than with acetabular fractures (n = 1). Floating hip injuries occur more frequently in younger
polytraumatised male patients. Pelvic fractures in floating hip injuries are operated more frequently (62.8% vs. 39.1%; p = 0.003) and the clinical course is significantly longer
(27.8 ± 19.3 vs. 19.9 ± 23.1 days; p < 0.001). However, the quality of treatment of pelvic fracture, exemplified by morbidity (18.6% vs. 14.6%; p = 0.610) and mortality (7.0% vs. 2.6%;
p = 0.108), shows no differences. Conclusion Injury severity and complexity of pelvic fracture is significantly higher in floating hip injuries, but without affecting the resulting
quality of treatment. A “femur first” treatment strategy is preferable. Algorithms for emergency treatment and definitive care are proposed in a flowchart.
Keywords
“floating hip” - acetabular fracture - pelvic ring fracture - femur fracture - femur first treatment strategy
