REFERAT

HIP JOINT DILOCATION

Preceptor : dr.M.BAYU RIZALDY,Ked (Surg)Sp.OT

HAIDIR,S.ked
DEFINITION AND ETIOLOGY
 Dislocation of the hip joint is a condition in which the
femoral head exits from its socket on the pelvis (pelvis)
 Causes of trauma with great force / pressure such as
vehicle accidents, pedestrians in a car or falling from a
height.

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ANATOMY
The femur is placed in
acetabulum by 5 separate
ligaments:
 Ligamen iliofemoral

 Ligamen pubofemoral

 Ligamen ischiofemoral

 Ligamen transverse
acetabular
 Ligamen femoral head

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 PATHOPHYSIOLOGY &
CLINICAL SYMPTOMS
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POSTERIOR DISLOCATION
Most often 80-90%
usually due to motor vehicle accidents
Pressure is transmitted in 2 ways:
- During rapid decelerations,knee hit the
dashboard and deliver pressure through
the femur to the pelvis.
- If the extension and knee limbs are
locked,pressure can be delivered from
floorboard through the upper limbs and
down to the hip joint.

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CLASSIFICATION OF POSTERIOR
DISLOCATIONS
The Thompson-Epstein classification is based on the
discovery of radiography, ie :
 Type I :Simple dislocation with or without an
insignificant posterior wall fragment
 Type II :Dislocation associated with a single large
posterior wall fragment
 Type III :Dislocation with a comminuted posterior
wall fragment
 Type IV :Dislocation with fracture of the acetabular
floor
 Type V :Dislocation with fracture of the femoral head 6
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The classification of Steward and Milford is based on the
stability of pelvic function, ie :
 Type 1 :No fracture or insignificant fracture

 Type 2 :Associated with a single or comminuted

posterior wall fragment, but the hip remains stable
through a functional range of motion
 Type 3 :Associated with gross instability of the hip
joint secondary to loss of structural support
 Type 4 :Associated with femoral head fracture

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Clinical symptoms
 The hip joint is in the position of flexion, adduction
and internal rotation
 The limbs look shorter
 Fingered on the pelvis of the pelvis

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ANTERIOR DISLOCATION
 Anterior dislocations are most often caused by
hyperextension pressure against an abducted limb so as
to lift the femoral head out of the acetabulum.
 Usually the femoral head remains on the lateral muscle
of the external obturator but may also be found beneath
it (obturator dislocation) or under the iliopsoas muscle
with a link to the superior pubic ramus (pubic
dislocation).

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KLASIFIKASI DISLOKASI SENDI
PANGGUL ANTERIOR MENURUT
EPSTEIN YAITU:
 Type I: Superior dislocations, including 
pubic and subspinous
 IA No associated fractures
 IB Associated fracture or impaction of 
the femoral head
 IC Associated fracture of the 
acetabulum
 Type II: Inferior dislocations, including 
obturator, and perineal
 IIA No associated fractures
 IIB Associated fracture or impaction of 
the femoral head 11
 IIC Associated fracture of the 
acetabulum
Clinical Symptoms
- The pelvic joint is in position of eksorotasi,
extension and abduction.
- There is no shortening of the legs.
- Benjoan in front of the inguinal region where the
head of the femur can be palpated easily.
- The hip joint is difficult to move.

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CENTRAL DISLOCATION
The central dislocation is fracture-dislocation, where the
head of the femur is located in the medial acetabulum of
the fracture. This is due to a lateral pressure against the
adductive femme found in motor vehicle accidents.

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Clinical Symptoms
- The pelvic position appears normal, only slightly
scuffed laterally
- Pelvic joint motion is limited

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SUPPORTING INVESTIGATION
From radiological examination found:
- Posterior dislocation
The embers of the femur are outside and above the
adductive and internal rotating femur acetabulum.
- Anterior dislocation
Femur's head is visible in front of the acetabulum.
- Central dislocation
Visible shifts and caput of the femur through the
pelvis.

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MANAGEMENT
1. Posterior dislocation accompanied by fracture
Treatment of this type with closed reduction 
and can be done with several methods Bigelow, 
Stimson, and Allis.

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THE STIMSON METHOD
 Patients in a prone position,
traumatized lower limbs are
left hanging
 The pelvis is immobilized
by pressing the sacrum
 The left hand doctor holds
an ankle and flexes 90º
 The right hand holds below
the area below the knee
 With the movement of
rocking and rotation and
direct pressure can be done 17
repositioning
METHOD BIGELOW
 Patients in the supine
position on the floor.
 Do the opposite traction
on the anterior superior
iliac spine region and the
ilium.
 The legs are 90º or more
in the abdominal area and
longitudinal traction is
performed.

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ALLIS METHOD
 Patients in supine
position.
 Immobilize the pelvis.

 Perform knee flexion of

90 º and lightly induced
limb and medial rotation.
 Performing vertical
traction and femoral head
lifted from the posterior
part of acetabulum.
 The pelvis and knees are
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carefully extruded.
2. Anterior dislocation
Treatment of this type of dislocation by closed reduction by
giving traction to the limbs in a state of flexion and internal
rotation and pelvic abduction followed by immobilization as in
the posterior dislocation.
3. Central dislocation
Treatment of this type of dislocation can by reduction requires
bone traction with K-wire for several weeks due to central
dislocation with an acetabulum fracture.

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Indication of operation:
 failed to reposition closed

 the position of the femoral cap is unstable

 koolum femoris fracture occurs

 presence of N.Ischiadikus lesions

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COMPLICATIONS
 Immediate complications
 Rupture of the bladder
 Rip urethra
 Trauma rectum and vagina
 Trauma to the nerves
 Advanced complications
 The formation of heterotrophic bone
 Avascular necrosis
 Impaired joint movement as well as secondary osteoarthritis
 Scoliosis compensator

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PROGNOSIS
 The prognosis of the dislocation of the hip joint depends on the
presence of other tissue damage, the initial management of the
dislocation and the severity of the dislocation.
 Overall, anterior dislocations have a better prognosis than
posterior dislocations. Research shows a poor prognosis occurs
in 25% of patients with anterior dislocation and 53% in
posterior dislocations.

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 The prognosis can also be seen from the classification of
Stewart and Milford.
 In grade I, long-term complications are common.
Avascular osteonecrosis occurs in about 4% of patients
and secondary osteoarthritis may also occur.
 Grade III and IV have a high risk for the occurrence of
avascular osteonecrosis.

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THANK YOU

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