This case conference discusses a 19-year-old male who was in a motorcycle accident where he was not wearing a helmet and collided with a sedan. He presented with right hip pain and inability to bear weight on his right leg. X-rays revealed a posterior dislocation of the right hip. The diagnosis, classification, presentation, associated injuries, management options including closed and open reduction techniques, and potential complications of posterior hip dislocations are reviewed. It was decided that the patient would undergo closed reduction of the hip under general anesthesia.

1. CASE CONFERENCE
15/05/60
Ext. รดาณัฐ วิจารณ์ RA +

2. Patient profile !
,ชายไทย อายุ 19 ปี+
Chief complaint!
,ปวดสะโพกขวา เหยียดขาไม่ได้ 30 นาที ก่อนมาโรงพยาบาล +
Present illness!
,30 นาทีก่อนมารพ. ผู้ป่วยขับรถมอเตอร์ไซค์ชนกับรถเก๋ง ไม่ได้สวมหมวกกันน็อค +
ไม่มีศีรษะกระแทก ไม่สลบ ปวดสะโพกขวา เดินลงน้ำหนักไม่ได้ มีบาดแผลถลอกตามร่างกาย +
มีแผลฉีกขาดที่หน้าและต้นคอด้านหน้า ไม่มีเสียงแหบ พูดได้ +

3. Primary survey !
A : ,Airway patent , can speak , can move neck , C-spine not tender +
B : ,Equal breath sound , chest compression test negative+
C : ,V/S stable [ BP 102/60 mmHg , PR 80 bpm ] +
D : ,E4V5M6 , pupil 2 mm RTL BE+
E : ,Avulsion wound 3cm at left side of neck , no active bleeding+
,Right leg – hip adduction , internal rotation and knee flexion +
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4. Secondary survey !
A : ,no history of food/drug allergy+
M : no current medication+
P : ,no underlying , Hx Right patella fracture S/P Sx +
L : ,last meal 11.00 [50min PTA]+
E : ,as in present illness ,+
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5. GA : A teenager Thai male , good consciousness +
Vital sign : BT , PR , BP , RR+
HEENT : not pale conjunctiva , anicteric sclera+
Neck : avulsion wound at neck (zone I) , no active bleeding , no horseness +
Heart : normal S1,S2 , no murmur +
Lungs : no dyspnea , trachea In midline , clear , equal breath sound both lungs +
Abdomen : soft , no tenderness+
Neuro : grossly intact +
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Physical examination!

6. Extremity+
,Right leg : +
, ,position – hip adduction , internal rotation and knee flexion+
, ,abrasion wound at knee and foot +
, ,tender at right groin , can’t extend hip +
, ,posterior tibial pulse 2+ +
,Right knee : +
, ,full ROM , no tenderness , no swelling +
, ,valgus and varus stress test negative +
, ,anterior drawer and posterior drawer test negative +
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Physical examination!

8. Film!
Both hip AP

9. Film!
Judet view

10. Film!
Judet view

11. Diagnosis+
Right posterior hip dislocation !

12. HIP DISLOCATION

13. CLASSIFICATION
SIMPLE VS. COMPLEX+ ANATOMIC CLASSIFICATION+
SIMPLE!
,pure dislocation +
,without associated fracture+
COMPLEX!
,dislocation+
+ ,fx of acetabulum or proximal femur+
POSTERIOR DISLOCATION (90%)+
ANTERIOR DISLOCATION !

14. POSTERIOR HIP DISLOCATION

15. POSTERIOR HIP DISLOCATION
Presentation !
• acute pain +
• inability to bear weight+
• deformity+
• Position +
,hip and leg in slight flexion ,
,adduction, and internal rotation!

16. ! Osteonecrosis+
! Posterior wall acetabular fracture+
! Femoral head fracture+
! Sciatic nerve injuries +
! Ipsilateral knee injuries (up to 25%)+
POSTERIOR HIP DISLOCATION
Associated injury!

17. POSTERIOR HIP DISLOCATION
X-Ray!
• femoral head smaller then contralateral side+
• Shenton's line broken+
• lesser trochanter internally rotated +AP pelvis !

18. POSTERIOR HIP DISLOCATION
CT scan! • helps to determine direction of dislocation, loose bodies, and
associated fractures+
• Post reduction CT !
,in traumatic hip dislocations +
to look for femoral head fx , loose bodies , acetabular fx +

19. POSTERIOR HIP DISLOCATION
Management!
• Non-operative+
• Closed reduction +
• Operative +
• Open reduction+
true orthopedic emergencies+
should be reduced within 6 hr+
Irreducible dislocation+
Sciatic n. injury caused by reduction+
Incongruent reduction +

20. POSTERIOR HIP DISLOCATION
Management!
CLOSED REDUCTION !
under GA / sedation+
Allis method+
Stimson gravity technique+
Bigelow and reverse Bigelow maneuvers +

21. Allis method!

22. Stimson gravity technique!

23. Bigelow meneuver!

24. POSTERIOR HIP DISLOCATION
Management!
CLOSED REDUCTION !
under GA / sedation+
After reduction +
CT scan (if possible) or Film +
Both hip AP , inlet , outlet , Judet views+

25. Management!
Set OR for closed reduction under GA+

26. Both hip AP+

27. Judet viw+

28. POSTERIOR HIP DISLOCATION
Complication!
• Osteonecrosis +
relate with time of reduction+
• Post traumatic arthritis +
up to 20% for simple dislocation+
markedly increased for complex dislocation+
• Sciatic nerve injury+
• Recurrent dislocations <2%+