This document discusses various injuries around the hip joint, including dislocation of the hip, fractures of the neck of femur, and intertrochanteric fractures of the femur. It describes the mechanisms, clinical presentations, investigations, treatments, and potential complications of each type of injury. Posterior dislocation of the hip is discussed in most detail, outlining the mechanism of injury, clinical signs, imaging findings, closed and open reduction techniques, and immobilization methods. Fractures of the neck of femur are also covered in depth, including classification systems, risk factors, anatomy, diagnosis, and various treatment options depending on patient factors.

1. • DR.BHARTI PAWAR
• (MSK PT)

2. INJURIES AROUND
HIP JOINT

3. INJURIES AROUND HIP
JOINT
DISLOCATION OF HIP
FRACTURES NECK OF
FEMUR
INTERTROCHANTRIC
FRACTURE OF FEMURE

5. DISLOCATION OF HIP JOINT

6. • The head of femur slips out
through the capsule and displaces
according to the direction of force.
• Dislocation of hip is serious injury
INTRODUCTION

7. POSTERIOR ANTERIOR CENTRAL
HIP DISLOCATION
{MOST COMMON}

8. POSTERIOR HIP DISLOCATION

9. 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
flexed femur Is pushed
backwards by violent thrust to
the knee.

10. CLINICAL SIGN
• Localized pain and tenderness
• • Attitude of limb- flex, add, IR
• • Shortening of limb
• Stiff and painful attempted movements
• Localized haematoma
• • Palpable posteriorly in gluteal region
• Diminished / absent femoral artery Pulsation
(Vascular sign of Narath)
POSTERIOR DISLOCATION
POSTERIOR : FLEXED ,INERNALLY
ROATATED ,AND ADDUCTED

11. INVESTIGATION
• Head out of acetabulum
• Thigh internally rotated
• Lesser trochanter less prominent
• Shenton's line is broken.
• Look for any bony chip.

12. TREATMENT
• Reduction is an emergency- more chance of being
avascular
• • Reduced under general anesthesia 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 for both - 6-8 weeks.
• • Mobilization started after 6-8 weeks

13. HIP SPICA
THOMAS SPLINT

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

15. • ANTERIOR DISLOCATION OF HIP

16. MECHANISM
• Rare
• Violent abduction force, with thigh flexed
• Occurs in RTAS
• Dislocated head of femur lies in obturator foramen of
symphysis pubis.

17. CLINICAL PRESENTATION
• • Attitude of limb- externally rotated
• • Head palpable in groin
• • Localized pain, stiffness, tenderness
• • Inability to bear weight
• • True lengthening of limb

18. COMPLICATIONS
• Avascular necrosis
• Injury to femoral nerve
• Osteoarthritis
• Myositis ossificans

19. • CENTRAL FRACTURE DISLOCATION OF HIP

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. X RAY:

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

24. • FRACTURE NECK OF FEMUR

25. • EPIDEMIOLOGY
• In elderly typically NOF # results from low energy falls and associated with
osteoporosis.
• in young typically NOF # result of a high energy mechanism and other associated
injuries are common.
• Mostly intra capsular and compromise blood supply of head of femur.

26. • History
• History of a traumatic event with the exception of patients who have stress
fractures of the femoral neck.
• young patients with high-energy femoral neck fractures have associated injuries
including head injuries.
• missed femoral neck fracture can be disastrous.

27. • Risk factors
• Female sex
• Increasing age
• Poor health
• Tobacco and alcohol use
• previous fracture
• Fall history
• Low estrogen level

28. • ANATOMY
• The upper femoral epiphysis closes by age16 years.
• Neck-shaft angle: 125-130 degrees
• Angle of Anteversion is 10-15 degrees

29. • Blood Supply
• major contributor is medial femoral
circumflex Artery
• some contribution to anterior and
inferior head from lateral femoral
circumflex
• some contribution from inferior
gluteal artery small and insignificant
supply from
• artery of ligamentum teres

31. • Subcapital
• Transcervical
• Basicervical
By location of fracture line(ANATOMICAL)

32. • GARDEN'S CLASSIFICATION
• Based on the degree of displacement of fracture and trabeculae.
• Garden classification is based on AP pelvis radiograph
• Stage I: incomplete fracture line (VALGUS IMPACTED)
• Stage II: complete fracture line; nondisplaced
• Stage III: complete fracture line; partially displaced
• Stage IV: complete fracture line; completely displaced

34. Pauwels classification
• The classification is based on the angle, the fracture line makes in reference to
the horizontal.
• Type I--fracture is between 0 and 30 degrees in Reference to the horizontal
• Type II--between 30 and 50 degrees
• Type III--more than 50 degrees

36. • DIAGNOSIS
• Diagnosis is based on:
• History
• Physical examination
• Radiographs.

37. • Physical examination
• On examination extremity is
shortened and externally
rotated

38. • RADIOGRAPH
• X Ray of Pelvis with both hip is more useful rather than xray of affected hip alone.
• X Ray Features:
• Break in medial cortex of neck.
• External rotation of femur is evident, the lesser trochanter appears more prominent.
• Overriding of greater trochanter, so that it lies at the level of Head of femur.
• Break in trabecular strem.
• Break in Shenton's Line.

40. • TREATMENT

45. Austin moore hip prosthesis
prosthesis
Thompson hip prosthesis

46. BIPOLAR PROSTHESIS

47. IMPLANTS

48. • Nonunion
• Avascular necrosis
• Osteoarthritis
COMPLICATIONS OF # N OF FEMURE

49. • Nonunion
• incidence of 5 to 30% increased incidence in displaced fractures
• TREATMENT:
• 1. Neck Reconstruction: The fracture is exposed from behind, the ends freshened
and the fracture stabilized with multiple screws and muscle-pedicle graft (Baksi's
procedure). Some surgeons use free fibular graft for reconstructing the neck.
• 2. Pauwel's osteotomy: This is a valgus ostestomy at the level of the lesser
trochanter such that he shearing forces are converted into compression forces.

51. • 3. Meyer's Procedure : In this
procedure, the fracture is reduced by
exposing it from behind. It is fixed
with multiple screws and
supplemented with a vascularized
muscle-pedicle bone graft taken
from the femoral attachment of the
quadratus femoris muscle.

52. • After a fracture through the neck, all the medullary blood supply and most of the capsular
blood supply to the head are cut off.
• The viability of the femoral head may therefore depend almost entirely on the blood
supply through the ligamentum teres.
• If this blood supply is insufficient, avascular necrosis of a segment or whole of the head
occurs
• TREATMENT:
• 1. In young patients treatment options are between bipolar arthroplasty (a special type of
prosthesis), Meyer's procedure or rarely total hip replacement (THR).
• 2. In elderly patients, a hemi-replacement arthroplasty is performed or .Total Hip
Replacement(THR)
Avascular necrosis

53. • Osteoarthritis
• It may be because of:
• avascular deformation of the head
• union in faulty alignment. The patient presents with pain and stiffness.
• TREATMENT:
• 1. Younger patients are treated by either an inter-trochanteric osteotomy.
• 2. For an elderly patient, total hip replacement is the best option.

54. •INTERTROCHANTRIC FRACTURE OF
FEMUR

55. • INTER-TROCHANTERIC FRACTURES
• Fractures in the inter trochanteric region of the proximal femur, involving either
the greater or the lesser trochanter or both

56. • PATHOANATOMY
• The distal fragment rides up so that the
femoral neck-shaft angle is reduced
(coxa vara).

60. • Clinical features
• The patient is brought in with a history of a fall or road accident.
• Pain in the region of the groin
• Swelling in the region of the hip
• Inability to move the leg
• Leg will be short and externally rotated
• Tenderness over the greater trochanter

62. • TREATMENT
• The main objective of treatment is to maintain a normal femoral neck-shaft angle
during the process of union. This can be done by conservative means (traction) or
by internal fixation.

63. • Conservative
methods
• Russell's traction and skeletal
traction in a Thomas splint.
• With the success of operative
methods, whereby, early mobilisation
is possible, conservative methods are
used less often.

64. • Operative methods
Dynamic Hip
Screw (DHS)
Proximal femoral
nail (PFN)
Gamma nail

67. •THANK YOU !