The Hip: Preservation, Replacement and Revision

Associated Injuries w/ Posterior Hip Dislocations

- See: Frx Dislocations of the Hip

- Discussion:
    - because of associated high energy trauma: look for other injuries
    - vast majority of patients sustained a hip dislocation will have associated injuries;
    - assoc ligamentous injuries to ipsilateral knee;
    - associated posterior wall fractures, femoral head, and shaft fractures;
    - posterior dislocations w/ femoral shaft frx may go unrecognized because classic clinical position of flexed, internally rotated, & adducted limb is not present;
    - in general, patients w/ posterior hip dislocations will have IR of the hip, where as patients w/ anterior dislocations will have external rotation of the hip;
            - if this is not the case, be suspicious for femoral neck or shaft frx, or an ipsilateral knee dislocation;
    - associated injuries: (proximal to distal);
            - blunt thoracic and abdominal trauma;
            - pelvic frx;
            - acetabular frx (including contra-lateral side);
            - femoral head frx:
                   - femoral head frx or neck frx may occur in upto 36%;
            - femoral neck frx:
            - femoral shaft frx;
            - sciatic nerve palsies;
                   - seen in 10-30% of cases;
                   - iatrogenic injury may be the result of laceration, penetration by drill bits, excessive traction by retractors, or prolonged extension of ipsilateral knee;
                   - it appears that injuries of peroneal division of sciatic nerve have a worse prognosis than injuries of the tibial division;
            - knee dislocation or ligament injuries;
            - patellar frx;
            - foot and ankle frx;

    - Case Example:
         - 25 yo male, wt 350 lbs, who was ejected from moving vehicle;
         - pts injuries included left brachial plexus and axillary artery disruption, left scapular frx, right knee and right hip dislocation;
               - right hip dislocation was initially missed on the portable x-ray, probably as a consequence of a poor quality x-ray along w/ patient's rotound body habitus;
               - note the asymmetry of the femoral heads and the absence of a joint space on the right side;
               - the radiograph on the far right was taken during the arteriogram


Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, September 6, 2012 11:44 am