Short Case 25 -Management of Hip Dislocation with ipsilateral shaft of femur fracture

Management of Hip Dislocation with ipsilateral shaft of femur fracture 

Anterior Dislcation	Posterior Dislocation
MOI- Abducted , Hip and knee flexed	Adducted
Lengthening	Shortening , Flexed adducted and IR
Type Superior – towards symphysis pubis Inferior – towards obturator foramen	No subtypes
Head Large	small

Hip Dislocation + SOF Fracture

Difficult with CR

1. Open reduction is an option .

    Kuntcher Nail

    Fracture at Isthmus level ,

    Transverse configuration

    Damage control surgery

2. Hip relocate

Fracute management

IM Fixation – best for long bone fracture

Closed reduction attempt otherwise open relocation .

How to critically analyse X-rays ?

Anatomic location of bone

Bone density

Rod Length

Alignment

Proximal screw

Nail

Nail in femur

Anterolateral bowing

Tibia Nail has Herzog’s angle – 11 degrees

This angle to negotiate with bone contour.

Note 

Hoop stress – during reaming or putting nail , tangential force to lateral cortex.