INJURIES OF THE HIP

DISLOCATION OF THE HIP

The injuries are classified according to the direction of dislocation anterior, posterior and central (
a comminuted or displaced fracture of the acetabulum)
Posterior hip dislocation Anterior hip dislocation
- Usually this occur in road traffic
accident when someone seated in
the car is thrown forwards, striking
the knee against the dashboard
- Femur is thrust upward and the
femoral head is forced out of its
socket
- Often piece of bone at the back of
the acetabulum is sheared off
making it fracture dislocation

Mechanism of
injury
- The usual cause is road traffic
accident or air crush
- Posteriorly directed force on an
abducted and externally rotated
hip
OR
- Weight falls onto the back of
(with the legs wide apart, knee
straight and back bent forwards


- causing the neck to impinge on
the acetabular rim and lever the
femoral head out in front
The leg is short
Adducted, internally rotated and
slightly flexed
However if one of the long bone is
fractured (usually femur) the
injury can easily be missed


Clinical features Leg is externally rotated,
abducted and slightly flexed
Seen from side view, the anterior
bulge of the dislocated head is
unmistakable ( especially of
superior variety)
Hip movement: IMPOSSIBLE

AP view
the femoral head is seen out of
the socket and above the
acetabulum
Segment of acetabulum
rim/femoral head may have been
broken off and displaced
Oblique view
Useful in demonstrating the size of
the fragment
X-ray AP view
Dislocation is obvious
Occasionally head is almost
directly in front of its norma
position
Lateral view
Doubt to be cleared
Thampson and epstein classification:-
Type I dislocation with NO more
than minor chip fracture
Type II dislocation with single
large fracture of posterior
acetabular wall
Type III posterior wall is
comminuted
Type IV has associated fracture
of the acetabular floor
Classification

It is classified based on its
position i.e
i. Anterior superior
ii. Anterior inferior
Dislocation must be reduce as
soon as possible under general
anaesthesia due to high risk of
avascular necrosis ( must be done
within 8 hrs)
Steps:-
i. Stabilize/ steady the pelvis
(by pushing it down
against the bed)
ii. The surgeon starts
applying traction in the ine
of the femur as it is lies
(usually internal rotation
and adduction)
iii. Gradually flexes the
patients hip and knee to
90
iv. A satisfying clunk
terminates the manoeuver
X- rays are essential to confirm the
reduction and to exclude the
fracture
Methods used:-
- Captain Morgans technique

Treatment Manoeuvre employed are similar
to those used to reduce a
posterior dislocation
Except that while the hip is flexed
upwards, it should be kept
adducted an assistant then
helps by applying lateral traction
to the thigh