Types and Treatment of Hip Dislocation:

Dislocations of hip are grievous injuries. Head of femur slips out through the weak inferior aspect of capsule and displaces according to direction of the force. It is commonly seen in high-energy injuries among young adults. 50% of cases are associated with fracture of acetabular lip, which may prevent reduction. They are easily missed when associated with fracture shaft of femur. Dislocations of hip are of three types:

• Posterior Dislocation (commonest)
• Anterior Dislocation
• Central Fracture Dislocation

POSTERIOR DISLOCATION OF HIP JOINT

Posterior dislocation of hip joint is the most common dislocation of hip. This is also known as Dashboard Injury.

Clinical Features

Usually the young adult is involved in a road traffic accident (RTA). Characteristically the limb is in flexion, adduction and internal rotation with appreciable shortening and painful restriction of movements. Head of femur may be palpable in the gluteal region.

Investigations

Anteroposterior view of pelvis shows the head lying outside the acetabulum. Shenton’s line shows a break in continuity. Occasionally the dislocation may be associated with fracture of the posterior lip of acetabulum.

Treatment

Reduction of the hip dislocation is an orthopaedic emergency. Dislocation is reduced by manipulation under general anaesthesia (GA). Reduction can be done by Following methods:

• Bigelow's method
• Stimson ' s method
• Classical Watson-Jones method

After-treatment: The limb is immobilized in a Thomas splint for 3 weeks in the position of abduction. Open reduction may be contemplated in cases of:

• Irreducible reductions
• Cases with fracture of the acetabular lip
• Instability/redislocation of hip.

ANTERIOR DISLOCATION

Anterior Dislocation is less common type of hip dislocation. It is seen in collision accidents when the motorist is hit on the medial aspect of the thigh with the thigh in flexion and abduction. Head of femur dislocates and may lie on the:

• Obturator foramen
• Symphysis pubis

Clinical Features

The limb is in external rotation and extension with apparent lengthening. Radiologically the femoral head may be present below the acetabulum.

Treatment

Reduction is achieved by manipulation under GA. Open reduction is attempted if closed manipulation fails.

Complications

Complications are injury to the femoral neurovascular bundle.

CENTRAL FRACTURE DISLOCATION

Central fracture dislocation is a rare type. It is caused by a violent injury on greater trochanter. Head of the femur is driven through the acetabulum. Depending upon the comminution and displacement of fracture fragments, Judet classified this as:

• Undisplaced fracture acetabulurn.
• Fracture acetabulum with intact weight bearing part
• Superior rim fracture
• Comminuted displaced fracture (bag of bones)

Clinical Features

Clinically the patient presents with severe pain in the hip with restriction of abduction and rotations. Per rectal examination is diagnostic with a bony mass palpable laterally.

Treatment

The aim of treatment is attaining congruous bone surface. This can be achieved by:

• Continuous skeletal traction to the leg with additional trochanteric pin traction with the thigh in 30 degree abduction for 8-12 weeks.
• Open reduction and internal fixation with reconstruction plates.

Complications

• Thrombophlebitis of iliac and femoral veins.
• Secondary osteoarthritis.
• Myositis ossificans
• Infection

Hip Dislocation is caused by violence directed in the line of shaft of femur with the hip flexed and adducted. This dislocation commonly occurs in automobile accidents with the occupants thrown forward and knee striking the dashboard. Call today for best Orthopedics Surgeons: (301) 645-5410

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