hip dislocation management
DESCRIPTION
Hip Dislocation ManagementTRANSCRIPT
![Page 1: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/1.jpg)
By Kenneth Lo
aka Dr Kate Ferguson
05/12/13
![Page 2: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/2.jpg)
• Hip is a modified ball and socket joint. • Femoral head is deep in the acetabular socket
– enhanced by the cartilaginous labrum.• Supported by fibrous joint capsule,
ischiofemoral ligament, muscles of upper thigh and gluteal region.
• Large amount of force needed to dislocated the joint – hence concurrent injuries
![Page 3: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/3.jpg)
![Page 4: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/4.jpg)
• Simple vs complex
• Complex associated with fractures.
• 3 main patterns in relation to acetabulum:- posterior, anterior, central.
![Page 5: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/5.jpg)
Posterior dislocation• Mostly posterior dislocation (80-90% of dislocations in
MVA)
• Force via a flexed hip – knee striking the dashboard and transmits force through femur and hip.
![Page 6: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/6.jpg)
• Posterior: - flexed, internally rotated, and adducted.
![Page 7: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/7.jpg)
Anterior Dislocation
• Femoral head situated anterior to acetabulum
• Hyperextension force against an abducted leg that levers head out of acetabulum.
• Also force against posterior femoral head or neck can produce dislocation
![Page 8: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/8.jpg)
• Anterior: The hip is minimally flexed, externally rotated and markedly abducted
![Page 9: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/9.jpg)
Central dislocation
• ALWAYS fracture dislocation
• Lateral force against an adducted femur – side impact MVA.
![Page 10: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/10.jpg)
Neurovascular examination• Signs of sciatic nerve injury include the
following:– Loss of sensation in posterior leg and foot– Loss of dorsiflexion (peroneal branch) or plantar
flexion (tibial branch)– Loss of deep tendon reflexes at the ankle S1,2
• Signs of femoral nerve injury include the following:– Loss of sensation over the thigh– Weakness of the quadriceps– Loss of deep tendon reflexes at knee L3, 4
![Page 11: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/11.jpg)
![Page 12: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/12.jpg)
![Page 13: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/13.jpg)
![Page 14: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/14.jpg)
1:Femoral(L2, L3, L4)
2:Obturator(L2, L3)
3: CommonFibular
![Page 15: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/15.jpg)
Treatment
• Whistler technique
• Stimson method
• Allis method
• Captain Morgan technique
• East Baltimore lift
![Page 16: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/16.jpg)
Whistler’s technique
• The patient lies supine on the gurney. • Unaffected leg is flexed with an assistant stabilizing the leg.
The assistant can also help stabilize the pelvis. • Provider's forearm is placed under the affected leg in the
popliteal fossa then grasps the knee of the unaffected leg. • Provider's other hand grasps the lower leg of the affected
leg, usually around the ankle. • The dislocated hip should be flexed to 90 degrees. • The provider's forearm is the fulcrum and the affected
lower leg is the lever. • When pulling down on the lower leg, it flexes the knee thus
pulling traction along the femur. • You can also add some internal/external rotation to
facilitate the reduction
![Page 17: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/17.jpg)
![Page 18: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/18.jpg)
• described primarily for acute posterior dislocations, but anterior dislocations can occasionally be reduced by this method
• believed to be least traumatic• pt is in prone position w/ lower limbs hanging from end
of table• assistant immobilizes the pelvis by applying pressure on
the sacrum• hold knee and ankle flexed to 90 deg & apply downward
pressure to leg just distal to the knee• gentle rotatory motion of the limb may assist in reduction
![Page 19: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/19.jpg)
![Page 20: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/20.jpg)
• Indications for open reduction– Irreducible dislocation (approximately 10% of
all dislocations)– Persistent instability of the joint following
reduction (eg, fracture-dislocation of the posterior acetabulum)
– Fracture of the femoral head or shaft– Neurovascular deficits that occur after closed
reduction
![Page 21: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/21.jpg)
Post reduction• After reduction, patients with hip dislocation should be
admitted to the hospital. Patients will be non-ambulatory and require a great deal of supportive care. Pain will be significant, even after reduction, and patients may require parenteral narcotics.
• The duration of traction and non–weight-bearing immobilization is controversial. Evidence suggests that early weight bearing (eg, 2 wk after relocation) may increase the severity of aseptic necrosis when it occurs.
• Early weight bearing decreases the incidence of other complications (eg, venous thromboembolism, decubiti),
![Page 22: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/22.jpg)
• Fracture-dislocations or concomitant fractures of the femoral neck usually require the expertise of an orthopaedic specialist.
• If relocation of the hip is successful, immobilize the legs in slight abduction by using a pad between the legs to prevent adduction until skeletal traction can be instituted.
• After reduction, patients with hip dislocation should be admitted to the hospital.
• The duration of traction and non–weight-bearing immobilization is controversial. Evidence suggests that early weight bearing (eg, 2 wk after relocation) may increase the severity of aseptic necrosis when it occurs.
• Early weight bearing decreases the incidence of other complications (eg, venous thromboembolism, decubiti), and some studies have found equivalent outcomes with early and delayed weight bearing.
![Page 23: Hip Dislocation Management](https://reader034.vdocuments.us/reader034/viewer/2022042512/554b5bcbb4c9051b458b4dd8/html5/thumbnails/23.jpg)
Complications• Early:
– Sciatic nerve injury (posterior dislocation)– Femoral-nerve injury– Fractures of head and neck– Femoral-artery injury (in anterior dislocations)
• Late:– AVN of the hip incidence of AVN increases with multiple attempts. – Osteoarthritis– Heterotopic calcification– Recurrent dislocation– Ligamentous injury of the knee, other fractures– Complications of immobilization (DVT, pulmonary embolus, decubiti,
pneumonia)