Dislocated Hip

Scenario

A 65 Year old male was brought into ED by ambulance after sustaining a fall at home.

This is an AP and Lateral plane film radiograph of a skeletally mature individuals pelvis and left hip. The most obvious abnormality is that there is a posterior dislocation of the left hip hemiarthroplasty.

Allis manoeuvre: stabilise the ASIS, then flex the knee of the affected side and hip and pull the knee upwards

Bigelow manoeuvre: grasp the affected limb at the ankle with one hand and place the opposite forearm behind the knee and apply longitudinal traction in line of the deformity. Adduct and internally rotate the thigh, the thigh should be flexed >90 degrees on the abdomen. Abduction and external rotation and extension of the hip is then performed. 

  • Rule out femoral head fracture
  • Rule out femoral neck fracture
  • Rule out acetabular fracture
  • Rule out loose bodies in hip joints

I would utilise the Posteriorlateral approach to the hip

Incision: Posterior to GT and 6cm distally down the femoral axis, proximally curved towards the PSIS 6cm proximally

Superficial dissection: Incise the fascia lata and Retract the gluteal muscle

Deep Dissection: Divide and reflect the short rotators.

  • Post traumatic arthritis
  • Femoral head osteonecrosis – 5-40% incidence, increased time to reduction
  • Sciatic nerve injury – 8-20% incidence, associated with longer time to reduction
  • Recurrent dislocation

Pipkin’s Classification

1

Femoral head fracture inferior to fovea capitus.

2

Femoral head fracture above the fovea capitus.

3

Femoral head fracture + neck of femur fracture

4

Femoral head fracture + acetabular fracture

Check XR to confirm relocation

Check NV status when patient GCS 15/15

Order CT hip 

  • Rule out femoral head fracture
  • Rule out femoral neck fracture
  • Rule out acetabular fracture
  • Rule out loose bodies in hip joints
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