Title Ortho Trauma LL ✅

LOWER LIMB TRAUMA HIP DISLOCATION Hip Dislocation POSTERIOR DISLOCATION ANTERIOR DISLOCATION CENTRAL DISLOCATION MOI → Common in MVA (passenger seated – knee flexed) → knee strikes the dashboard → femur thrust proximally → femur head forced posteriorly (out of socket) → fracture – dislocation (Dashboard injury) Others: Industrial accidents, sports injuries MOI Violent abduction due to road accidents / blow from the back during squat position - More commonly a/w femoral head # MOI A fall on the side or blow over the greater trochanter → Force the femoral head medially through the floor of acetabulum - Usually a/w fracture of acetabulum → shortening of Bryant’s triangle (above GT) CF Leg is ● Shortened ● Adducted ● Internally rotated ● Slightly flexed CF Leg is ● Externally rotated ● Abducted ● Slightly flexed ● Anterior bulge of dislocated head CF ● Severely shocked ● Bruising around the hip ● Gross limitation of hip movement ● Limb may be internally rotated Iman, Izzaty, Nisa, Lissa (4/3/21) Forti
X-Ray Femoral head lying above and behind the acetabulum X-Ray Occasionally the head is almost directly in front of its normal position - lesser trochanter more prominent X-Ray dislocation of the femoral head from the acetabulum +/- acetabulum # Tx Need to be reduced within 6 hours → risk of osteonecrosis , subsequent osteoarthritis Closed reduction (under GA) Assistant steady the pelvis → the knee flexed at 90 degrees→ gradually flexes the patient’s hip, internal rotation and adduction to achieve reduction. Bigelow’s Maneuver, Allis maneuver, A satisfying ‘clunk’ indicates that reduction has been achieved. Tx Closed reduction (under GA) The affected leg is held in external→ rotation, abduction and flexion, before longitudinal→ gently rotated internally and externally until the hip reduces The reduction is usually obvious and accompanied by a palpable or even audible clunk. Apply lateral traction Tx (Serious injuries) EMERGENCY TREATMENT -Counteract shock and reduce dislocation -Apply skeletal traction - Distal femur - Weight 10kg will suffice - Lateral traction through greater trochanter CONSERVATIVE TREATMENT Closed reduction: (CMR , traction ), immobilization , rehab - Minimal displacement (in the weight bearing zone , <3mm) - Displaced fracture do not involve in weight-bearing segment → (roof) acetabulum - Fracture in elderly – where closed reduction is Iman, Izzaty, Nisa, Lissa (4/3/21) Forti
-Avoid if a/w femoral neck # as to prevent further displacement femoral neck supply that may disrupts blood supply to femoral head Traction (Maintenance) -Skin traction / skeletal traction through the upper tibial pin -3 weeks -After 3 weeks, patient is allowed to walk with crutches but avoid any weight bearing feasible -Medical contraindication to operative tx (sepsis) OPERATIVE TX Internal/ External fixation - Indicated for unstable hips and fractures -Resulting in significant distortion of ball and socket congruence -# fixed with lag screws or special buttressing plate COMPX Early ● Sciatic nerve injury ● Vascular injury (sup gluteal artery torn) ● Associated fractured femoral shaft Late ● Osteonecrosis ● Secondary osteoarthritis ● Myositis ossificans COMPX Early ● Sciatic nerve injury ● Vascular injury ● Associated fractured femoral shaft Late ● Osteonecrosis ● Secondary osteoarthritis ● Myositis ossificans COMPX ● Sciatic nerve injury ● Acetabular fractures ● Avascular necrosis (Osteonecrosis of the femoral head may occur even if the hip is not fully dislocated) ● Infection Iman, Izzaty, Nisa, Lissa (4/3/21) Forti
Iman, Izzaty, Nisa, Lissa (4/3/21) Forti