Hip Dislocation

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

• 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

• 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.

• 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

• 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

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

• Common complications are Avascular Necrosis, Post-traumatic Osteoarthritis, Sciatic Nerve Injury, Heterotrophic ossification, Thromboembolism