This document discusses different types of hip dislocations: posterior, anterior, and central. Posterior dislocation is the most common, occurring when the flexed and adducted femur is pushed backwards. It can be classified using Thompson-Epstein or Pipkin systems. Clinical signs include pain, limb position, and shortening. Treatment involves closed or open reduction and immobilization. Complications can include nerve injury, osteonecrosis, and arthritis. Anterior and central dislocations have similar but different mechanisms, clinical presentations, and treatments.

1. DISLOCATION OF
HIP JOINT
D R . 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 of hip 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

6. POSTERIOR
DISLOCATION
OF HIP

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
• Localized pain 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
Type Description
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
Type Description
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 out of acetabulum
• Thigh internally rotated
• Lesser trochanter less prominent
• Shelton’s line is broken.
• Look for any bony chip.

12. TREATMENT
• Reduction is an 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.

13. STIMONS GRAVITY METHOD

14. HIP SPICA THOMAS SPLINT

15. COMPLICATIONS
• Injury to sciatic nerve
• Avascular necrosis
• Osteoarthritis
• Myositis ossificans

16. ANTERIOR
DISLOCATION
OF HIP

17. MECHANISM
• Rare
• Violent abduction 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
• Attitude of limb- externally
rotated
• Head palpable in groin
• Localized pain, stiffness,
tenderness
• Inability to bear weight
• Apparent lengthening of
limb
TREATMENT AND COMPLICATIONS ARE SAME.

19. CENTRAL
FRACTURE-
DISLOCATION OF
HIP

20. MECHANISM
• Femoral head is 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
• Severe localized 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.

22. INVESTIGATION

23. TREATMENT
• Aim of treatment 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).

25. QUESTIONS??

26. THANK YOU…