Dear all, This ppt contains the cause, types, clinical and radiological features, treatment and complication of dislocation of the Hip. I hope this is useful to you. Thank you

1. By :- Dr. Bindesh D. Patel, PT
Deputy Registrar
P P Savani University
Dislocation of Hip

2. • Classification
1. Posterior
2. Central
3. Anterior

3. Posterior dislocation of Hip
• Head of femur is pushed out of acetabulum
• Fracture dislocation :- chip fracture of the
posterior lip of acetabulum

4. Mechanism of injury
• Violence directed along the shaft of the femur,
with the hip flexed.
• Occurs in motor accident called dashboard
injury.

5. Diagnosis
• Pain, swelling, deformity (Fle, Add, IR)
• Shortening of leg
• Head may be felt in the gluteal region
• May be missed when associated injury are
there like femoral shaft fracture
• It may got unnoticed in unconscious patients
• So X-ray of pelvis is common in all fracture

7. • Radiological features of X-ray
– Femoral head is out of acetabulum
– Lesser trochanter is not seen
– Shentons’s line is broken
– Also look for chip of bone
– Opposite side comparison is necessary
– CT scan can also be done

8. Treatment
• It is an emergency due to chances of
becoming avascular
• Manipulation under general anesthesia
• Chip will fall in place along with the reduction

9. • Open reduction may required where
1. Closed reduction fails
2. There is intra-articular loose fragment is there
3. Acetabulum fragment is large and it is weight
bearing part

10. Technique of closed reduction
• Patient is anesthetized and placed supine on
floor
• An assistant grasps pelvis firmly
• Surgeon flexes the hip and knee at right angle
and exerts axial pull.
• Sound of reduction is heard after which hip
can be moved in all directions.
• Leg is kept in light traction with hip in
abduction for 3 weeks.

11. Complications
1. Injury to sciatic nerve
• Neuropraxia : Recovers spontaneously
• Major injury :- Surgical exploration is required,
prognosis is poor.

12. 2. Avascular necrosis of the femoral head
• Changes appears on X-ray after 1-2 years of an
injury.
• Hip replacement

13. 3. Osteoarthritis
• Cause may be avascular head or an
incongruous acetabulum and femoral head
• Total hip replacement

14. 4. Myositis ossificans
• Occurs few weeks after the
injury
• X-ray shows mass of fluffy
new bones around hip
• Treatment is rest and
analgesics

15. Anterior dislocation of Hip
• Rare injury
• Occurs when leg is forcibly abducted and
externally rotated
• Fall from tree when foot gets stuck or during
road traffic accident
• Limb is in true lengthening with the head
palpable in groin region
• Treatment and complication are same as
posterior one.

17. Central fracture dislocation of Hip
• Common
• Head is driven through the medial wall of the
accetabulum towards the pelvis cavity
• Displacement varies
• Skeletal traction is applied laterally and
distally
• Immobilization for 8-12 weeks

18. • Surgical reconstruction of the acetabular floor
in some young individuals
• Joint stiffness and osteoarthritis is common
complication

19. By :- Dr. Bindesh D. Patel, PT
Deputy Registrar
P P Savani University
Fracture of neck of femur

20. • Two types
1. Intra capsular (Fracture of neck of femur)
2. Extra capsular (Inter trochanteric fracture)

21. Pathoanatomy
• Displaced fracture with the distal fragment
externally rotated and proximally migrated.
• Capsule prevents extreme rotation and
dispalcement

22. Classification
1. Anatomical classification
1. Subcapital
2. Transcervical
3. Basal

23. 2. Pauwels classification
• Based on the angle of inclination of the
fracture in relation to the horizontal plane
• Three types
• More the angle, the more unstable fracture

24. 3. Gardens classification
• This is based on rotation displacement of the
distal fragment
• Degree of displacement is judged from the
change in directions of the medial trabecular
stream of the neck in relation to the bony
trabeculae in the weight bearing part of the
head and in the corresponding part of the
acetabulum.

27. Mechanism
• In elderly occurs by a trival fall
• Osteoporosis
• In adult due to more severe injury
• Fracture is uncommon in children

28. Diagnosis
• Pain in groin
• Patient may walk even with fracture
• In elderly patient inability to move limb,
inability to take weight on limb, fracture by
trivial injury
• Pain and swelling in groin

29. • Examination may reveal
– Leg is in ER, patella facing lateral
– Shortening of leg
– Tenderness in groin
– Hip movement painful and associated spasm
– Active SLR not possible
• Can be differentiated from inter-trochanteric
fracture

30. • Radiological features
– Both side X-ray, pelvis
included
– Break in medial cortex of
the neck
– ER of femur is evident,
lesser trochanter is more
prominent
– GT will be at the level of
head of femur
– Break in trabecular
stream
– Break in shenton’s line

31. Treatment
• Conservative treatment is not used commonly
because
• Blood supply to the proximal fragment is cut
off
• It is difficult to achieve reduction and
maintain it because the proximal fragment is
too small
• Operative treatment is done

32. • Impacted (undisplaced) fracture
– Conservative management
– Internal screw to stabilize it
– Children hip Spica
– Adult Thomas splint

33. • Unimpacted (Displaced fracture)

34. Displaced
Age below 60
Closed reduction
under X-ray
Reduction done,
Multiple screw
fixation
Reduction not
possible, ORIF
Age above 6o
Prosthetic
replacement
Normal hip,
Hemiarthroplasty
Pre-existing
arthritis, Total Hip
replacement

35. • Internal fixation techniques
– Multiple cancellous screws
– Screws are partially threaded
– Threaded part holds in the head whereas the
smooth part permits controlled collapsed of the
fracture
– No external immobilization needed
– Patient can sit, walk with crutches

36. • Mcmurrys osteotomy
– At the base inter-trochanteric
region
– Osteotomy is medially upward
– Distal fragment is displaced
medially and is abducted
– Hip spica or internal fixation
with screw of plates
– It converts shearing stress into
compressive stress
– Now a days rarely used

37. • Hemiarthroplasty
– Unipolar and bipolar prosthesis

38. • Meyers procedure
– Fixed with multiple screws and supplemented
with a vascularized muscle pedicle bone graft.

39. • Late presented cases
– Elder patients :- Hip replacement
– Adult patients :-
– Check for femoral neck blood circulation

40. Complications
1. Non union
• Treatment depends upon the age of patient
and vascular necrosis of femoral head
• Age above 60 :- Replacement arthroplasty
• Younger patients :-
• Neck reconstruction procedure
• Pauwel’s osteotomy :- Valgus osteotomy

41. 2. Avascular necrosis
• Treatment options
are arthrodesing
the hip, biploar
arthroplasty,
Meyers procedure
and THR.

42. 3. Osteoarthritis
• Younger patients :- Inter-trochanteric
osteotomy, Arthrodesis
• Elder patients :- THR

43. Thank you

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