DISLOCATION OF HIP

POSTERIOR DISLOCATION
ANTERIOR DISLOCATION
CENTRAL DISLOCATION

POSTERIOR DISLOCATION
Usually in a car accident in a truck or
car is thrown forward strikingknee
against dashboard
Mostly in a driver worker, taxy driver
etc

POSTERIOR DISLOCATION
Clinical Features:
the leg is short and lies adducted,
internally rotated and
slightly flexed.
The golden rule is to x-ray the pelvis in every case of
severe injury and, with femoral fractures, to insist on
an x-ray that includes both the hip and knee.

POSTERIOR DISLOCATION
Xray Photos

POSTERIOR DISLOCATION
Xray Photos

Treatment

The dislocation must be reduced as soon as

In the vast majority of cases this is performed

closed, but if this is not achieved after two or three

possible under general anaesthesia.

attempts an open reduction is required.

Treatment

by applying traction in the line of the femur as it lies (usually in

and then gradually flexes the patients hip and knee to 90

degrees, maintaining traction throughout.

At 90 degrees of hip flexion, traction is steadily increased and

adduction and internal rotation),

sometimes a little rotation (either internal or external) is required

to accomplish reduction

Another assistant can help by applying direct medial and anterior

pressure to the femoral head through the buttock

Complication
EARLY
Sciatic nerve injury
Vascular injury
Associated fractured femoral shaft
LATE
Avascular necrosis
= 10% of trauma hip. If reduction delay than 12 hours
the figure rises to 40%.
Myositis ossificans
Unreduced dislocation
Osteoartrhitis.

Prognosis

if the reduction was per- formed promptly (within 6 hours), then

but if there was a longer delay then an extended period of 12

weeks may be wiser.

no more than 6 weeks should suffice,

Anterior dislocation

nowadays the usual cause is a road accident or air

crash

Clinical Features

The leg lies externally rotated, abducted and

Seen from the side, the anterior bulge of the

slightly flexed.
dislocated head is unmistakable, especially when
the head has moved anteriorly and superiorly.

Anterior dislocation

Central Dislocation

A fall on the side, or a blow over the greater

through the floor of the acetabulum. Although this

is called central dislocation, it is really a fracture

trochanter, may force the femoral head medially

of the acetabulum

Dislocation of knee
Clinical Features
1. Rupture of the joint capsule produces a leak of
the haemarthrosis, leading to severe bruising
and swelling.

2.

the diagnosis is straightforward as there is gross

defor- mity

3.

The circulation in the foot must be examined

because the popliteal artery may be torn or

Dislocation of knee
Clinical Features
1. the films occasionally reveal a fracture of the
tibial spine or posterior part of the plateau
(cruciate ligament avulsion),

2.

avulsion of the fibular styloid or avulsion of a

fragment from the near the edge of the lateral
tibial condyle (the Segond fracture).

Treatment
Reduction under anaesthesia is urgent
this is usually achieved by pulling directly in
the line of the leg,

but hyperextension must be avoided because

of the dan- ger to the popliteal vessels.

the limb is rested on a back-splint and the

circulation is checked repeatedly during the 48

hours.

Complication
Early
Arterial damage
Nerve Injury
Late
Joint instability
Stiffness

Dislocation of Patella
If the dislocation has reduced
spontaneously, the knee may be
swollen and there may be bruising
and tenderness on the medial side.
If the dislocation has reduced
spontaneously, the knee may be
swollen and there may be bruising
and tenderness on the medial side.

IMAGING
Anteroposterior, lateral and
tangential (skyline) x-ray views are
needed.
MRI may reveal a soft-tissue lesion
(e.g. disruption of the medial
patellofemoral ligament) as well as
artic- ular cartilage and/or bone
damage.

TREATMENT
In most cases the patella can be pushed
back into place without much difficulty
and anaesthesia is not always necessary
the exception is an intra-articular
(intercondylar) dislocation, which may
need open reduction.
If there are no signs of soft tissue rupture
i.e. there is minimal swelling, no
bruising and little ten- derness cast
splintage alone will usually suffice.

TREATMENT
The cast is retained for 2 or 3 weeks and
the patient then undergoes a long period
(23 months) of quadriceps strengthening
exercises.

Complication
Recurrent dislocation : 1520 per
cent chance of suffering further
dislocations

Imaging

PERONEAL DISLOCATION
Acute dislocation of the peroneal
tendons may accom- pany or may be
mistaken for a lateral ligament strain.
Recurrent subluxation or dislocation is
unmistak- able; the patient can
demonstrate that the peroneal tendons
dislocate forwards over the fibula
during dor- siflexion and eversion.

PERONEAL DISLOCATION
Treatment in a below- knee cast for 6
weeks will help in a proportion of
cases; the remainder will complain of
residual symptoms.

PERONEAL DISLOCATION