DISLOCATION OF HIP JOINT

DISLOCATION• Joint surfaces are completely

displaced

• Clinical features• Pain

• Restriction of movements

• Limb held in characteristic position

• Signs

• Abnormal shape of joint

• Displaced bony landmarks

• Investigation

• X-RAY, CT

• Treatment

• Reduction

• Immobilization

• rehabilitation

• Complications

HIP JOINT DISLOCATION

According to direction of femoral

head displacement

• Posterior

• Anterior

• Central

BLOOD SUPPLY

POSTERIOR DISLOCATION

• Dashboard injury

• Clinical features

• Short leg

• Adducted

• Internally rotated and slightly flexed

• In every case of severe hip

injury X-RAY PELVIS.

• If femoral shaft #

X-RAY HIP AND KNEE

THOMPSON AND EPSTEIN CLASSIFICATION

Types Description

i Dislocation with no more than minor chip #

ii Dislocation with single large fragment of posterior acetabular wall

iii Dislocation with comminuted fragments of posterior acetabular wall.

iv Dislocation with # through acetabular floor.

v # through acetabular floor and femoral head

ANTERIOR DISLOCATION

• Mechanism

• Clinical features

• Externally rotated, abducted and

slightly flexed leg

• Anterior bulge of dislocated

head.

EPSTEIN’S CLASSIFICATIONTypes Description

i Superior (pubic) dislocation

ia Simple (no assc #)

ib With # of head or neck of femur

ic Dislocation with # of acetabulum

ii Inferior dislocation (obturator )

iia Simple

iib # of head or neck of femur

iic # of the acetabulum

CENTRAL DISLOCATION

• Mechanism

• Clinical features

• No shortening , no ext rotation

deformity, no externally palpable

head.

• Neutral limb

• Severe pain and restriction of movts

CLASSIFICATION (JUDET’S TYPE)

Undisplaced #

Inner wall #

Superior dome #

Bursting #

PHYSICAL EXAMINATION

• Inspection

• Attitude

• swelling

• Palpation

• greater trochanter

• Head of femur

• tenderness

MEASUREMENTS

• Bryant’s triangle

• Nelaton’s line

• Schoemaker’s line

• Morris’ bitrochanteric test

• Chiene’s test

• Length of lower limb

MOVEMENTS

• X-Ray

Treatment• Posterior dislocation

• Allis method(reduction)

• Type I

•Closed

•Hip protection

• Post-reduction x-ray

• Type ii

• Open reduction

• Type iii, iv, v

• Indications for open reduction

• Failed closed reduction

• Failed stability test

• Large acetabular fragment

• # of femur head

• Sciatic nerve palsy

ANTERIOR DISLOCATION

• Same as posterior except that while flexed knee is being pulled and hip gently flexed upwards it should b kept adducted.

CENTRAL DISLOCATION

• Skeletal traction

• Open reduction

• Primary arthroplasty

COMPLICATIONS OF HIP DISLOCATION

• Early

• Sciatic nerve injury

• Vascular injury

• # femoral shaft

• Late

• Avascular necrosis

• Myositis ossificans

• osteoarthritis

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