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    Hip Dislocation Presentation

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    Hafizah Hoshni
    The document discusses different types of hip dislocations including posterior, anterior, and central dislocations. It describes the mechanisms of injury, clinical features, treatments including closed and open reduction techniques, and potential complications for each type of hip dislocation.

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    © All Rights Reserved
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    Hip Dislocation Presentation

    Uploaded by

    Hafizah Hoshni
    212 views24 pages
    The document discusses different types of hip dislocations including posterior, anterior, and central dislocations. It describes the mechanisms of injury, clinical features, treatments including closed and open reduction techniques, and potential complications for each type of hip dislocation.

    Original Description:

    HAFIZAH BINTI MOHD HOSHNI HIP DISLOCATION ORTHOPEDICS

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    The document discusses different types of hip dislocations including posterior, anterior, and central dislocations. It describes the mechanisms of injury, clinical features, treatments including closed and open reduction techniques, and potential complications for each type of hip dislocation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    212 views24 pages

    Hip Dislocation Presentation

    Uploaded by

    Hafizah Hoshni
    The document discusses different types of hip dislocations including posterior, anterior, and central dislocations. It describes the mechanisms of injury, clinical features, treatments including closed and open reduction techniques, and potential complications for each type of hip dislocation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 24

    Hip Dislocations

    Hip
    • The hip is a ball and socket joint
    • Reinforced by ligaments, the joint capsule, and
    large muscle insertions. Consequently, a large
    amount of force is required to dislocate the hip.
    • A hip dislocation is a true orthopedic
    emergency. The incidence of subsequent
    avascular necrosis (AVN) of the femoral
    head is a time-dependent phenomenon,
    becoming more likely to occur if reduction
    is delayed beyond 6 hours.
    Hip Dislocation

    • Posterior hip dislocation


    • Anterior hip dislocation
    • Central hip dislocation (fracture-
    dislocation)
    Posterior dislocation
    • 90% of hip dislocation cases
    • The head of femur pushed out of the
    acetabulum posteriorly.
    • Mechanism of injury
    – Also known as dashboard injury
    – Violence directed along the shaft of femur with the
    hip flexed
    – Most commonly in an MVA, when the knee strikes
    against the dashboard
    Posterior dislocation
    • Clinical features
    – history of great force applied to a flexed knee and
    hip.
    • The affected limb is
    – shortened, adducted, and internally rotated
    – the hip and knee held in slight flexion.
    • Patient may be unable to walk or adduct the leg.
    • Signs of vascular or sciatic nerve injury may be present.
    – Pain in hip, buttock, and posterior leg
    – Loss of sensation in posterior leg and foot
    – Loss of dorsiflexion (peroneal branch) or plantar flexion (tibial
    branch)
    – Loss of deep tendon reflexes at the ankle
    Posterior dislocation

    • X-rays
    – Femoral head out of acetabulum.
    – Thigh internally rotated, therefore the lesser
    trochanter becomes less prominent
    – Shenton line is broken
    • Treatment
    – Closed reduction
    • 2 common manoeuvres – Allis & Stimsom
    Posterior dislocation
    – Preferably under GA /deep sedation
    – Allis manoeuvre
    – Patient placed supine on the floor
    – Assistant holds the pelvis down firmly
    – The other person, flexes the hip & knee at
    right angles & exerts an axial pull
    – Usually a ‘click’ will be heard once the hip is
    reduced & the hip can moved in all directions
    Posterior dislocation
    2. Stimson manoeuvre
    – With the patient placed prone, allow the dislocated leg to hang over
    the edge of the bed with the hip and knee at 90 degrees of flexion.
    – With an assistant providing stabilizing pressure to the pelvis, apply
    force to the calf and gradually increase until relocation is
    accomplished.
    – Although this technique is often more successful than the Allis
    technique, it has the disadvantages that the knee may be injured if
    too great a force is applied to the popliteal area.

    – The leg kept in light traction with hip abducted for 3


    to 6 weeks.
    Posterior dislocation

    • Complications
    1. Sciatic nerve injury
    – Lies behind posterior wall acetabulum
    – Pain in hip, buttock, and posterior leg
    – Loss of sensation in posterior leg and foot
    – Loss of dorsiflexion (peroneal branch) or plantar flexion
    (tibial branch)
    – Loss of deep tendon reflexes at the ankle
    • Recovers spontaneously
    Posterior dislocation

    2. Avascular necrosis
    • Occurs in 15 – 20% of cases.
    • The changes appear on X-ray generally 1 –
    2 years post injury.
    • Avascular head appears dense & gradually
    collapses
    • Patient c/o hip pain after a seemingly
    painless period post treatment
    Posterior dislocation
    3. Osteoarthritis
    • Late complication of hip dislocation
    • Cause: sequelae of AVN or incongrous acetabulum
    & femoral head
    • Initial treament – conservative.
    • THR may be required later
    4. Myositis ossificans
    • Occurs few weeks to months post injury.
    • Patient c/o hip pain & stiffness
    • X-ray: may show a mass of new bone around hip
    • Treatment: rest & analgesia
    Anterior dislocation

    • Rare injury
    • Mechanism of injury
    – Anterior hip dislocations occur when force is
    applied to an abducted leg that levers the hip
    anteriorly out of its articulation.
    – For e.g. fall from a tree when foot gets stuck
    & the hip abducts excessively
    Anterior dislocation
    • Clinical features
    – The leg is
    • externally rotated, abducted, and extended at the hip. The
    femoral head may be palpated anterior to the pelvis.
    – Signs of injury to the femoral nerve or artery may be
    present.
    • Paresis of lower extremity
    • Dull, aching pain in lower extremity
    • Weak or absent reflexes at knee
    • Lower extremity pale and/or cool to touch
    • Paresthesias of lower extremity
    Anterior dislocation
    • X-ray
    – The femur is abducted and externally rotated while
    the head of the femur is medial and inferior to the
    acetabulum.
    • Treatment
    – Similar technique of reduction of posterior hip
    dislocation except that
    • While the flexed thigh is pulled upwards, it should be
    adducted
    – The subsequent Rx is similar to posterior dislocation.
    Central hip dislocation

    • A central dislocation in which a direct


    impact to the lateral aspect of the hip
    forces the hip centrally through the
    acetabulum into the pelvis.
    • Also known as a fracture/dislocation.
    Central hip dislocation
    • Clinical features
    • The leg is
    – shortened, abducted or adducted, and internally or externally
    rotated depending on the type and extent of penetration into
    the pelvis.
    • The typical posture of the leg with anterior or posterior hip
    dislocation may not be seen if an associated femoral shaft
    fracture is present.
    • The leg distal to the fracture assumes a neutral position,
    masking the usual rotation seen with a dislocation. The
    incidence of missed hip dislocation is much higher in the
    presence of a femoral shaft fracture.
    Central hip dislocation
    • X-ray
    – The femoral head displaced medially and the
    acetabular floor fractured

    • Treatment
    – The displacement of the head varies from
    minimal to the whole head lying inside the
    pelvis.
    – Joint stiffness & OA are inevitable.
    Central hip dislocation
    – Therefore the main aim of RX is to get a congruous
    articular surface as much as possible.
    – For this to occur
    • Skeletal traction is applied distally & laterally.
    • If fragments fall into place and reasonably reconstitute the
    articular margins, the traction is continued for 8-12 weeks.
    – For some, reconstruction of acetabular floor may be
    needed if the fragments do not fall back in place by
    traction
    Central hip dislocation

    • Complications
    1. Joint stiffness
    2. OA
    Open reduction
    • Indications for open reduction
    – Irreducible dislocation (approximately 10% of
    all dislocations)
    – Persistent instability of the joint following
    reduction (eg, fracture/dislocation of the
    posterior acetabulum)
    – Fracture of the femoral head or shaft
    – Neurovascular deficits that occur after closed
    reduction

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