Hip Dislocations and its management

 Approach to patient  with a hip dislocation


  AP radiograph showing a posterior hip.      dislocation

    ATLS Protocol is followed. Don't miss to say X-ray pelvis, C-spine lateral view and CXR-AP view                        to r/o other injuries

                document NV status of limb along with findings on hip

                additional view of Hip Lateral and CT-Hip joint incase there is a acetabulum fracture

                adequate analgesia 

                pelvic specialist consultation 

  How to treat this injury ?

     Consenting , explain risk of fracture

      CR of hip 

       Bigelow Procedure

                        Patient on supine , assistant stabilizes Pelvis via ASIS 

                        Surgeon - traction ,Adduction and IR 

     If CR fails, OR via Posterior approach.


What are precautions after Reduction we take  ?

        Confirm under C-arm

         EUA - to assess stability

         Distal femoral pin to maintain hip reduction for traction

          Post-operative CT scan to confirm concentric reduction, r/o fracture fragments inside jts,  characterize posterior wall #s.

        NV examination when patients recover from anesthesia


Indications for fixing posterior wall fractures 

        Lack of joint congruity

        Instability ( 20 % wall involved - joint stable, 20-40 % wall involved -joint unstable)

        Fracture > 30 % of the wall to maintain the reduction

  How to fix posterior wall fractures ?
        Posteior approach

        Screw fixation / Butress Plating

https://surgeryreference.aofoundation.org/orthopedic-trauma/adult-trauma/acetabulum/posterior-wall/orif-through-kocher-langenbeck

        Counselling - Early complications     

                                        Infection

                                        Sciatic Nerve Injury

                              Long term complications

                                         Heterotopic ossification    

                                         AVN

                                        OA 

Indomethacin is routinely used to minimize risk of heterotopic ossification.

LMWH to reduce risk of DVT and PE. 

              

        

          

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