- 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;
- 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
Posterior fracture dislocation of the hip with fractures of the femoral head.
Reduction of posterior dislocation of the hip in the prone position.
Treatment of unreduced traumatic posterior dislocations of the hip.
Computed tomography evaluation of stability in posterior fracture dislocation of the hip.
Reduction of posterior dislocation of the hip in the prone position.