Hip Dislocations

HIP DISLOCATIONS
Classification
Anterior dislocation : superior / inferior
Posterior dislocation
Central fracture-dislocation



Leg Positions in Hip Dislocations: A. Posterior dislocation B. Anterior Dislocation
ANTERIOR DISLOCATION OF HIP
Epstein Classification of Anterior Dislocation
Type I : Superior dislocations, including pubic and subspinous
IA : No associated fractures
IB : Associated fracture or impaction of femoral head
IC : Associated fracture of acetabulum
Type II: Inferior dislocations, including obturator and perineal
IIA : No associated fractures
IIB : Associated fracture or impaction of femoral head
IIC : Associated fracture of acetabulum
Mechanism of Injury
Almost always due to high-energy trauma.
Direction of force and position of hip determine the type of dislocation
Superior Dislocation : Hip in abduction, external rotation and extension during injury
Inferior dislocation : Hip in abduction, external rotation and flexion during injury


Examination
Hip flexed, externally rotated and abducted
Exclude femoral vessels and nerve injuries (rare)
X-rays
AP view of pelvis and lateral view of affected hip
Management
Exclude life-threatening injuries; resuscitate if appropriate. Call Ortho Registrar early. This may be reducible in the Emergency Department.
Patient will require emergency M&R under GA
Keep NBM, IV drip
FBC, U/E/Cr/Glu, GXM 1 pint, ECG, CXR
IM voltaren 50 - 75mg for analgesia
Admit to Ortho Dept if no GS conditions
Inform Ortho MO of case

POSTERIOR DISLOCATION OF HIP
Thompson and Epstein Classification of Posterior Dislocation
Type I : Simple dislocation
Type II : Dislocation associated with a single large posterior wall fragment
Type III : Dislocation associated with comminuted posterior wall fragments
Type IV : Dislocation with fracture of the acetabular floor
Type V : Dislocation with fracture of the femoral head

Mechanism of Injury
Hip in flexion, with force directed on the flexed knee (e.g. dashboard injury)
If hip is in neutral or slightly adducted position: simple dislocation
If hip is in abducted position: fracture of the posterior-superior rim of acetabulum
Examination
Hip flexed, internally rotated and adducted
Exclude sciatic nerve injury
X-rays
AP view of pelvis and lateral view of affected hip
Management
Exclude life-threatening injuries; resuscitate if appropriate. Call Ortho Registrar early. This may be reducible in the Emergency Department.
Patient will require emergency M&R under GA
Keep NBM, IV drip
FBC, U/E/Cr/Glu, GXM 1 pint, ECG, CXR
IM voltaren 50 - 75mg for analgesia
Admit to Ortho Dept if no GS conditions
Inform Ortho MO of case