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Hip Dislocation

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

 

TRAUMATIC HIP DISLOCATION –SUMMARY
  • Hip dislocations are traumatic hip injuries that result in femoral head dislocation from the acetabular socket.
  • Generally occurs due to high-energy trauma commonly involving unrestrained occupants in RTAs
Patient presents with acute pain, inability to bear weight, deformity
ANATOMIC CLASSIFICATION
-posterior dislocation(most common) –flexion, internal rotation, adduction deformity
-anterior dislocation- minimal flexion, external rotation, abduction deformity
-inferior(obturator)
-superior(iliac or pubic)
  • 95% of dislocations with associated injuries( hence follow ATLS )such as femoral head, neck, or shaft fractures, acetabular fractures, pelvic ring fractures
  • neurologic injuries.(sciatic nerve-15%),Knee injuries(89%)
  • Diagnosis can be made with hip radiographs to determine the direction of dislocation and CT scan studies to assess for associated injuries.
 Thompson-Epstein classification
  • Type 1 – With or without minor fracture
  • Type 2 – With large, single fracture of posterior acetabular rim
  • Type 3 – With comminution of rim of acetabulum, with or without major fragments
  • Type 4 – With fracture of the acetabular floor
  • Type 5 – With fracture of the femoral head
Other classifications
  • STEWART AND MILFORD CLASSIFICATION
  • PIPKIN CLASSIFICATION –Femoral HEAD FRACTURES
  • BRUMBACK CLASSIFICATION
  • Treatment is emergency reduction to minimize risk of avascular necrosis followed by CT scan to assess for associated injuries that may require surgical treatment (loose bodies, femoral head fractures, acetabular fractures).
  • For dislocations without associated fractures an attempt of closed reduction that result in a congruent reduction is definitive
The popular methods of achieving closed reduction of hip
  1. The Bigelow maneuver
  2. Allis maneuver
  3. .Stimson gravity technique
  4. Whistler technique
  5. Captain Morgan technique
  6. EAST BALTIMORE LIFT
  • IN cases of Irreducible dislocation, fracture of acetabulum/femoral head that need excision or ORIF, Iatrogenic sciatic nerve injury, Incongruent reduction, open reduction is done
-posterior approach
-anterior approach
  • Common complications are Avascular Necrosis, Post-traumatic Osteoarthritis, Sciatic Nerve Injury, Heterotrophic ossification, Thromboembolism
Post Views: 1,170

Related Posts

  • Surgical Dislocation of Hip

    Courtesy: Dr Thiago Busato MD, Hip Surgeon, Curitiba, Brazil

  • Hip Dislocation- Sciatic Nerve Injury

    Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

  • Classification and Types of Hip Dislocation

    Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

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