- See:
Posterior Frx Dislocations of the Hip
- Discussion:
- simple posterior dislocation without a fracture occurs from a posteriorly
directed force against a flexed and adducted femur;
- Associated Injuries:
- Pre-Reduction Radiographs: (
radiographic evaluation of hip dislocation:)
- AP of the Hip;
-
pelvic series radiographs (
AP,
inlet and outlet);
-
acetabular series radiographs (
Judet views);
- radiograph of the femur and knee;
- CT scan:
- performed in all cases to identify intra articular frag or assoc frx;
- Closed Reduction:
- performed as soon a possible ( < 8-12 hrs)
- either in OR under GEA (optimal) or in ER w/ sedation if delays are expected;
- reduction may be performed w/ flouro, but the orthopaedist may find that
flouro interferes w/ hip flexion, which frequently is essential to performing
an atraumatic reduction;
- frequently all that is needed is one assistant to apply pressure to the
ASIS, as the surgeon flexes the hip while applying traction;
- the reduction is felt as a gentle clunk, at which point radiographs
are obtained;
- other reduction methods include:
-
Gravity Method of Stimson
-
Allis's maneuver
-
Bigelow's Maneuver
- Open Reduction of Posterior Dislocations:
- Post-Reduction Radiographic Assesment:
-
radiographs:
- need to asses for congruency w/ repeat of pre-reduction radiographs;
- any widening of the joint space after reduction should suggest the
possibility of loose fragments in the joint incomplete reduction
of a fractured femoral head fragment, or soft tissue interposition;
- objective measurements include the distance from the femoral head to the
ilioischial line compared to the contralateral hip;
-
CT scan:
- always get post reduction CT scan to r/o iatrogenic
posterior wall frx;
- 2 mm slices are required to help asses congruence;
- note the distance of anterior joint surface to femoral head as
compared to the contralateral side;
- more than 0.5 mm difference is signifiant;
- small fragments which are located inferiorly, away from the wt bearing dome,
do not necessarily need to be removed if the joint is congruent;
- post reduction 3 anatomical areas should be assessed;
- femoral head;
- femoral neck;
- acetabulum;
- Post Reduction Treatment:
- avoid: flexion, internal rotation, and adduction;
- have abduction pillow present prior to closed reduction;
- traction is maintained until pt. is pain free (2 wks)
- most often a
femoral traction pin will be used for traction;
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Posterior fracture dislocation of the hip with fractures of the femoral head.
Traumatic Posterior Fracture-Dislocation of the Hip with Fracture of
the Femoral Head or Neck, or Both.
Reduction of posterior dislocation of the hip in the prone position.
Herwig-Kempers A.
Veraart BE.
Journal of Bone & Joint Surgery - British Volume. 75(2):328,1993 Mar.
Treatment of unreduced traumatic posterior dislocations of the hip.
Operative Management of Displaced Femoral Head Fractures: Case Matched Comparison
of Anterior versus Posterior Approaches for Pipkin I and Pipkin II Fractures;
MF Swiontkowski, M Thorpe, JG Seiler, and ST Hansen.
J. Orthop Trauma. Vol 6. No 4. pp 437-442.
pp 1992.
Computed tomography evaluation of stability in posterior fracture
dislocation of the hip.
Clin Orthop 1988;227:152-163.
Zych GA, Latta L, et al:
Keith JE, Brashear HR Jr, Guilford WB:
Stability of
posterior fracture-dislocation of the hip.
J Bone Joint Surg
1988;70A:711-714.
Reduction of posterior dislocation of the hip in the prone position.
Herwig-Kempers A.
Veraart BE.
Journal of Bone & Joint Surgery - British Volume. 75(2):328,1993 Mar.
