Hip dislocation: Difference between revisions

Revision as of 06:01, 12 February 2012

Background

Orthopedic emergency; reduction should occur w/in 6hr
High-energy trauma is primary mechanism
Types:
- Posterior
  - 90% of hip dislocations
  - Acetabular fractures may result as well
- Anterior
  - 10% of hip dislocations
  - Can be superior (pelvic) or inferior (obturator)
  - Neurovascular compromise is unusual

Clinical Features

Posterior Dislocation
- Extremity is shortened, internally rotated, and adducted

Imaging

Hip AP and lateral views
Also consider Judet views or CT to evaluate acetabulum (esp for posterior dislocation)

Management

Reduce

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-Trauma is primary mechanism. In adults, requires substantial force vectors (MVC, fall from a height)
+*Orthopedic emergency; reduction should occur w/in 6hr
+*High-energy trauma is primary mechanism
+*Types:
+**Posterior
+***90% of hip dislocations
+***Acetabular fractures may result as well
+**Anterior
+***10% of hip dislocations
+***Can be superior (pelvic) or inferior (obturator)
+***Neurovascular compromise is unusual
-Because of force required, 50% will have other fractures or significant injuries
+==Clinical Features==
+*Posterior Dislocation
+**Extremity is shortened, internally rotated, and adducted
-===Epidemiology===
+==Imaging==
-% posterior (10% central or anterior)
+*Hip AP and lateral views
+*Also consider Judet views or CT to evaluate acetabulum (esp for posterior dislocation)
-Posterior = force applied to flexed knee and hip (e.g. dashboard)
+==Management==
+*Reduce
-Anterior = direct blow to posterior hip or posterior force to abducted leg
+[[File:Hip_Reduction.jpg]]
-Central = direct impact to lateral aspect.
-Mortality primarily due to associated injuries
-Head, thorax & pelvis
-==Diagnosis==
-Shortened, adducted & internally rotated. Hip and knee in slight flexion
-NB: not true if there is associated femoral fx
-Look for:
-#Loss of sensat posterior leg/foot (sciatic nerve)
-#Loss of dorsiflexion (peroneal branch) or plantar flexion (tibial branch)
-#LE pale / cool to touch (femoral art)
-==Workup==
-Usually obvious, but can be subtle on single AP view
-Typically femoral head is seen lateral and superior to acetabulum
-CT very accurate, and helps especially in delineating acetabular injury (where plain films are notoriously poor)
-==Treatment==
-===Reduction===
-Multiple techniques described (Allis/Stimson)
-All involve longitudinal traction to unlock the femoral head, with gentle internal/external rotation to seat it in the acetabulum
-ED success rate for native hip dislocation/reduction unclear
-(10% reported, but not a pure series)
-==Prognosis==
-#Other injuries/life threats
-#Avascular necrosis (AVN)
-##Occurs in 10-20% of cases
-##Time-dependant phenomenon
-##6-hours is the cut-off
-#Sciatic Nerve injury: 10-15%
-##Usually neuropraxia with eventual recovery expected
-##Incidence of this 2.5X with delay > 6 hours for reduction
-##Osteoarthritis: 10%-35%  30-70% after open-reduction
 ==Source==
-ACEP ('09)
+*Tintinalli
 [[Category:Ortho]]