Hip dislocation

Definition:-
1) Hip dislocation occurs when the head of the femur is forced out of its socket in the hip bone (pelvis). It typically takes a major force to dislocate the hip.

2) A hip dislocation a disruption of the joint between the femur and pelvis.
3) A hip dislocation occurs when the ball-shaped head of the femur (thigh bone) moves out of its socket on the pelvis. In most cases, this requires a traumatic force to the thigh bone.

1. HIP DISLOCATION DR. NIRAJ KUMAR MPT ORTHO HIOD/ASSOCIATE PROFESSOR SGRRIMHS,PATEL NAGAR

2. Definition:- 1) Hip dislocation occurs when the head of the femur is forced out of its socket in the hip bone (pelvis). It typically takes a major force to dislocate the hip. 2) A hip dislocation a disruption of the joint between the femur and pelvis. 3) A hip dislocation occurs when the ball shaped head of the femur (thigh bone) moves out of its socket on the pelvis. In most cases, this requires a traumatic force to the thigh bone.

3. CAUSES OF HIP DISLOCATION Very severe violence to causes a dislocation of a normal hip joint:- 1.Fall from height 2.Industrial injury 3. RTA

4. Types of dislocation 1.Posterior dislocation 2.Anterior dislocation 3.Central dislocation

5. Posterior dislocation:- DEFINITION:- Posterior dislocation is the commonest type of dislocation. It is due to violence applied along the femoral shaft when hip is in flexed, adducted & internal rotatated position. It is seen automobile accident –When the passenger sitting by the driver is thrown forward, his knee hitting against the dashboard Posterior dislocations comprise approximately 80-90% of hip dislocations caused by MVCs. The femoral head is situated posterior to the acetabulum.

6. Nine out of ten hip dislocations are posterior. The affected limb will be in a position of flexion, adduction, and internally rotated in this case. The knee and the foot will be in towards the middle of the body. A sciatic nerve palsy is present in 8%-20% of cases

7. During rapid deceleration, the knees strike the dashboard and transmit the force through the femur to the hip. If the leg is extended and the knee is locked, force can be transmitted from the floorboard though the entire lower and upper leg to the hip joint. A posterior dislocation is shown in the image below.

8. CLINICAL FEATURE 1. Severe pain , Swelling &Tenderness 2 . Inability to sand or walk 3. The position of limb is in adduction +flexion + Internal rotation 4. Shortening 5. GT is raised & head of femur felt posterior under Gluteal muscles 6. paralysis- sciatic nerve injury- foot drop

9. X- YAY=AP VIEW OF PELVIS

10. MANAGEMENT Dislocation is reduced by manipulation under GA After reduction the limb can be placed in normal position and a firm elastocrepe spica bandage is applied to the hip & leg is immobilized in a Thomas splint for 3 to 4 weeks NSAID along with MR is the choice of Tx for pain and for reduce the tension of muscle Full weight bearing allowed after six week

11. TECHNIQUE OF MANIPULATION OF POSTERIOR HIP DISLOCATION 1] Flex the hip and knee to 90º and apply steady forward traction. The head slips forward into position. 2] Bigelow technique:- Patient in supine position on a mattress surgeon stand & gripping the pt. leg by knee & ankle bending . While assistant fixed the pelvis with both hand than surgeon leg circumducted through external rotation , abduction, and extension results the head felt to reduced with audible sound.

12. ANTERIOR DISLOCATION OF THE HIP 1] Femoral head situated anterior to acetabulum 2] In an anterior dislocation the limb is held by the patient in externally rotated with mild flexion and abduction. Femoral nerve palsies can be present, but are uncommon. 3] Hyperextension force against an abducted leg that levers head out of acetabulum. Also force against posterior femoral head or neck can produce anterior dislocation 10 % to 15% of traumatic hip dislocation.

13. Mechanism of Anterior Dislocation • Extreme abduction with external rotation of hip. • Anterior hip capsule is torn or avulsed. • Femoral head is levered out anteriorly. Types of anterior dislocation 1] Obturator type:- In this type HOF slips forward & lies over the obturater foramen. 2] Pubic type:- In this type HOF slips forward & lies near the pubis symphysis . • Perineal type:- In this type HOF felt anteriorly in medial aspect of groin.

14. Central dislocation A central dislocation a rare type of dislocation and it is always a fracture-dislocation. This is caused by a violent lateral aspect of the hip and lateral force against an adducted femur as commonly seen in side impact MVCs. Floor of acetabulum get multiple fracture HOF is pushed into the pelvis. C/F:- Severe pain in the hip, fl & Ext movt. relatively free but limitation of abduction & rotation. And some time hemispherical bulge of lateral wall of rectum. Treatment:- Continuous heavy skeletal traction is applied to limb with 30 degree abduction for 4 to 6 weeks. Sometime surgical fixation of articular surface is done.

15. Physical Therapy DURING IMMOBILISATION Acutely after successful reduction , 1. Rest and icing the hip and taking anti-inflammatory and/or narcotic medications to reduce pain are helpful. 2. Non-Weight bearing with the help of crutches should begin immediately after the patient is pain free and transitioned to full weight bearing as pain allows . 3. Strong Isometrics to Glutei, Hip Flexor, Quads & Hams 4. In skeletal traction small ROM can be initiated by 3 wks. 5. Avoid- Hip adduction & IR with Flexion in post. Dislo Hip abduction & ER in ant. Disl .

16. DURING MOBILISATION 1. Full range of motion of the hip joint. 2. Mobilization of knee. 3. Hip & Leg muscle strengthening exercises may begin as hip flexors, hip extensors, and the muscles nearest the hip, including the quadriceps and hamstrings. 4. Ambulating without crutches . (FWB). 5. Assisted SLR should be initiated. 6. Controlled hip movement after 12 wks. 7. Independent Ambulation after 15-16 wks. 8. C ardiovascular training may be attempted, which should include brisk walking and swimming. Jogging or running may begin at 6-8 weeks but will differ by individual athlete and injury. Full return to sports is generally within 3-4 months.

17. Complications Nerve injury. Injury to the sciatic nerve may cause weakness in the lower leg and affect the ability to move the knee, ankle and foot normally. Osteonecrosis . It can tear blood vessels and blood supply to the bone is lost, the bone can die, resulting in osteonecrosis (also called avascular necrosis). Arthritis. The protective cartilage covering the bone may also be damaged, which increases the risk of developing arthritis in the joint.

18. THANKS