Traumatic dislocation of hip joint

Causes Diagnosis Management
  • Direct blow to the hip through the long axis of the femur.
  • This is common in road traffic accident and causes posterior dislocation, which occurs with the hip in flexion and adduction.
  • Anterior dislocation is uncommon
  • Central dislocation is caused by fall from height when the hip is extended and abducted.
  • Central dislocation occurs with fracture of acetabulum.
  • Fracture of acetabulum may also be a complication of anterior and posterior dislocations.
  • Sciatic nerve injury is a common complication of all dislocations
 
  • History: e.g. Road traffic accident.
  • Inspection: In posterior dislocation, the thigh is medially rotated and abducted. In anterior dislocation, the thigh is laterally rotated, flexed and abducted. Central dislocation causes shortening of lower extremity.
  • Loss of function with restricted movement.
  • Painful hip
  • X-ray:
  • Reduction is carried out with patient lying down on a mattress. While the pelvis is held to the ground by an assistant, the surgeon pulls the knee up to provide traction on the femur with external rotation for posterior dislocation and internal rotation for anterior dislocation and no rotation at all for central dislocation.
  • For unstable and large acetabular fracture with acetabular fragment use double hip spica or Thomas' splint.
  • Skeletal traction is used for central fracture dislocation.
  • Immobilize in Thomas' splintThomas' splint with skin traction for 6 weeks initially or with single hip plaster for stable fracture and double hip plaster for unstable ones for 6 weeks.
  • Next allow mobilization without weight bearing for another 6 weeks before full use.
  • Open reduction with hip exposure can be performed if reduction is not achievable by closed means.

A bad fall

Cause of posterior dislocation

Cause of central dislocation

Cause of posterior dislocation
 
Anterior dislocation Central dislocation Posterior dislocation
 

Double and single plaster hip spica                    l

 

Electronic School of Medicine
Creator: Oluwole Ogunranti