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Dislocation of hip joint
- 1. DISLOCATION OF HIP JOINT DR . K R U PA R A I T H AT H A A S S I S T A N T P R O F E S S O R , S C H O O L O F P H Y S I O T H E R A P Y , R K U N I V E R S I T Y , R A J K O T , G U J A R A T , I N D I A
- 3. INTRODUCTION • Dislocation ofhip is serious injury. • The head of femur slips out through the capsule and displaces according to the direction of force.
- 4. TYPES • Posterior Dislocation(the commonest) • Anterior Dislocation • Central Dislocation
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- 7. MECHANISM • Commonest • 50%of cases , it is associated with a chip fracture of posterior lip of acetabulum, in which case it is known as a fracture- dislocation. • It occurs when – adducted and flexex femur is pushed backwards by violent thrust to the knee.
- 8. CLINICAL SIGNS • Localizedpain and tenderness • Attetude of limb- flx, add, IR • Shortening of limb • Stiff and painful attempted movements • Localized haematoma • Palpable posteriorly in gluteal region • Diminished / absent femoral artery pulsation
- 9. CLASSIFICATION THOMPSON AND EPSTEIN CLASSIFICATION TypeDescription I with or without a minor fracture II with a large single fracture of the posterior acetabular rim III with comminution of the acetabular ring IV with a fracture of the acetabular floor V with a fracture of the femoral head
- 10. CLASSIFICATION PIPKIN CL ASSIFICATION TypeDescription I Fracture below the fovea; not involving weight-bearing surface of the head II Fracture above the fovea; involving weight-bearing surface of the head III Type I or II fracture with associated femoral neck fracture IV Type I or II fracture with associated acetabulum fracture
- 11. INVESTIGATIONS • Head outof acetabulum • Thigh internally rotated • Lesser trochanter less prominent • Shelton’s line is broken. • Look for any bony chip.
- 12. TREATMENT • Reduction isan emergency- more chance of being avascular • Reduced under general anaesthesia by classical Watson- jones axial traction technique. • old dislocation, failure of closed reduction, intra articular loose fragment,large acetabular fragment--- cause of open reduction. • immobilization after both- 6-8 weeks. • Mobilization started after 6-8 weeks.
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- 14. HIP SPICA THOMASSPLINT
- 15. COMPLICATIONS • Injury tosciatic nerve • Avascular necrosis • Osteoarthritis • Myositis ossificans
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- 17. MECHANISM • Rare • Violentabduction force, with thigh flexed • Occurs in RTAs • Dislocated head of femur lies in obturator foramen of symphysis pubis. • Types: pubic, obturator, perineal.
- 18. CLINICAL PRESENTATION • Attitudeof limb- externally rotated • Head palpable in groin • Localized pain, stiffness, tenderness • Inability to bear weight • Apparent lengthening of limb TREATMENT AND COMPLICATIONS ARE SAME.
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- 20. MECHANISM • Femoral headis driven through the medial wall of the acetabulum towards the pelvic cavity. • Displacement varies: from minimal- to as much as whole head in pelvis. • Mechanism- Fall on greater trochanter, or RTAs.
- 21. CLINICAL FEATURES • Severelocalized pain and stiffness • Hip abduction and rotation markedly restricted with severe pain • Bony mass is palpable in per rectal examination • Limb remains in neutral rotation and short.
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- 23. TREATMENT • Aim oftreatment in these cases is to achieve as congruous an articular surface as possible. • For that skeletal traction is applied distally and laterally. • If fragments fall in place- cont. for 8-12 weeks; if not- surgical reconstruction of the acetabular floor may be necessary. • Full weight bearing started after 3 months (after radiographic evidence of consolidation).
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