Dislocations and Fracture Dislocations of the Hip

ANTERIOR

·         10-15% of hip dislocations

·         Limb externally rotated and abducted

Treatment

·         Closed reduction - multiple attempts not advisable

·         If CR unsuccessful perform open reduction via anterior type approach

Technique

Allis's maneuver

·         Patient supine, knee flexed, assistant stabilises pelvis and applies lateral traction force to inner thigh

·         Longitudinal traction, hip slightly flexed, adducted and internally rotated to reduce

Complications

·         Neurovascular compromise - direct pressure on femoral artery, vein or nerve

·         Post traumatic arthritis develops in 30%

·         AVN less than in posterior dislocation ~ 8% of cases

POSTERIOR

·         80% of hip dislocations

·         Limb internally rotated and adducted

·         Neutral/adduction at time of injury - simple dislocation only

·         Abduction at time of injury - fracture posterior acetabular wall

Complications

·         Associated knee ligament injuries especially PCL, posterolateral complex

·         Sciatic nerve injury 10-14%

·         Superior gluteal artery injury