HIP TRAUMA

HIP TRAUMA
• Hip dislocation • Fracture neck of femur • Intertrochanteric fracture • Subtrochanteric fracture


HIP DISLOCATIONS
• Typically occur in young adults following high-energy trauma. • – Axial loading; position of the hip determines the direction of the dislocation. • – 90 % of hip dislocations are posterior.
CLASSIFICATION
• • Simple: hip dislocation with no associated fracture • • Complex: hip dislocation with associated acetabular or proximal femur fracture
• Anatomic classification • – Posterior dislocation (90 %) • • Hip flexed, adducted, and internally rotated • • “Dashboard injury” • – Increased hip flexion and internal rotation at the time of injury decreases the risk of associated fracture.
• Anterior dislocation • • Hip extended, abducted, and externally rotated
IMAGING
• • AP pelvis: dislocated femoral head appears smaller than the contralateral side (posterior dislocation); discontinuity of Shenton’s line; carefully assess femoral neck for possible fracture. • • Lateral hip: confirm direction of dislocation.
• Postreduction CT scan mandatory: assess for loose bodies, incarcerated fragments, femoral head fracture, and acetabular fracture.
TREATMENT
• • Nonoperative • – Emergent closed reduction within 6 h; evaluate hip stability postreduction • • Closed reduction contraindicated with ipsilateral femoral neck fractures