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Hip Dislocations and Femoral Head Injuries

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Hip Dislocations and Femoral Head Fractures ,[object Object],[object Object],[object Object]
Introduction ,[object Object],[object Object],[object Object],[object Object]
Anatomy: Hip Joint ,[object Object],[object Object],[object Object],[object Object]
Joint Contact Area ,[object Object],[object Object],[object Object]
Acetabular Labrum ,[object Object],[object Object],[object Object]
Hip Joint Capsule ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Femoral Neck Anteversion ,[object Object],[object Object],[object Object]
Blood Supply to Femoral Head ,[object Object],[object Object],[object Object]
Blood Supply to Femoral Head ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sciatic Nerve ,[object Object],[object Object],[object Object],[object Object]
Hip Dislocation: Mechanism of Injury ,[object Object],[object Object],[object Object]
Posterior Dislocation ,[object Object],[object Object]
Type of Posterior Dislocation depends on: ,[object Object],[object Object],[object Object]
Hip Position vs. Type of Posterior Dislocation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Mechanism of Anterior Dislocation ,[object Object],[object Object],[object Object]
Effect of Dislocation on Femoral Head Circulation ,[object Object],[object Object],[object Object],[object Object]
Associated Injuries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Associated Injuries ,[object Object],[object Object],[object Object],[object Object]
Associated Injuries ,[object Object],[object Object],[object Object],[object Object]
Classification ,[object Object],[object Object]
Thomas and Epstein Classification of Hip Dislocations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
AO/OTA Classification ,[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluation: History ,[object Object],[object Object]
Physical Examination: Classical Appearance ,[object Object]
Physical Examination: Classical Appearance ,[object Object],[object Object],[object Object]
Unclassical presentation (posture) if: ,[object Object],[object Object],[object Object]
Physical Examination ,[object Object],[object Object],[object Object],[object Object]
Radiographs: AP Pelvis X-Ray ,[object Object],[object Object],[object Object],[object Object],[object Object]
Reasons to Obtain More X-Rays Before Hip Reduction ,[object Object],[object Object],[object Object]
X-rays after Hip Reduction: ,[object Object],[object Object],[object Object]
CT Scan ,[object Object],[object Object],[object Object],[object Object],[object Object]
MRI Scan ,[object Object],[object Object]
Clinical Management: Emergent Treatment ,[object Object],[object Object],[object Object]
Emergent Reduction ,[object Object],[object Object],[object Object],[object Object]
Anesthesia ,[object Object],[object Object],[object Object]
General Anesthesia if: ,[object Object],[object Object],[object Object]
Reduction Maneuvers ,[object Object],[object Object],[object Object],[object Object],[object Object]
Allis Maneuver ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reduced Hip ,[object Object],[object Object],[object Object],[object Object]
Stability Test ,[object Object],[object Object],[object Object],[object Object]
Irreducible Hip ,[object Object],[object Object],[object Object],[object Object],[object Object]
Hip Dislocation: Nonoperative Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hip Dislocation: Indications for Operative Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
1. Irreducible Hip Dislocation: Anterior ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],1. Irreducible Hip Dislocation: Posterior
Irreducible Posterior Dislocation with Large Femoral Head Fracture ,[object Object],[object Object]
Three Options ,[object Object],[object Object],[object Object],[object Object],[object Object]
2. Hip Dislocation with Femoral Neck Fracture ,[object Object],[object Object],[object Object]
2. Hip Dislocation with Femoral Neck Fracture ,[object Object],[object Object],[object Object],[object Object]
3. Incarcerated Fragment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
4. Incongruent Reduction ,[object Object],[object Object],[object Object],[object Object],[object Object]
5. Unstable Hip after Reduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Results of Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of Hip Dislocation ,[object Object],[object Object],[object Object]
Post-traumatic Osteoarthritis ,[object Object],[object Object],[object Object],[object Object]
Recurrent Dislocation ,[object Object],[object Object],[object Object]
Recurrent Dislocation Caused by Defect in Posterior Wall and/or Femoral Head ,[object Object],[object Object],[object Object]
Delayed Diagnosis of Hip Dislocation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Sciatic Nerve Injury ,[object Object],[object Object],[object Object],[object Object]
Sciatic Nerve Palsy: If No Improvement after 3–4 Weeks ,[object Object],[object Object]
Foot Drop ,[object Object],[object Object],[object Object]
Infection ,[object Object],[object Object]
Infection: Treatment Principles ,[object Object],[object Object],[object Object],[object Object]
Iatrogenic Sciatic Nerve Injury ,[object Object],[object Object]
Iatrogenic Sciatic Nerve Injury ,[object Object],[object Object],[object Object],[object Object],[object Object]
Thromboembolism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Femoral Head Fractures ,[object Object]
Femoral Head Fractures – Mechanism ,[object Object],[object Object]
History and Physical Examination ,[object Object],[object Object]
Classification ,[object Object],[object Object]
AO/OTA Classification
Pipkin Classification ,[object Object],[object Object],[object Object],[object Object]
Pipkin, JBJS , 1957
Pipkin I AO/OTA 31-C1.2
Pipkin II AO/OTA 31-C1.3
Pipkin III ,[object Object]
Pipkin IV ,[object Object],[object Object]
Femoral Head Fracture: Radiographic Evaluation ,[object Object],[object Object],[object Object],[object Object]
CT Scan ,[object Object]
Nonoperative Treatment If: ,[object Object]
Displaced Infra-foveal Fractures ,[object Object],[object Object],[object Object]
Posterior vs Anterior Approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Supra-foveal Fractures ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
Surgical Dislocation of the Hip for Fractures of the Femoral Head Helfet, Lorich et al, J Orthop Trauma , 2005
 
 
 
Pipkin III Fractures ,[object Object],[object Object],[object Object]
Femoral Head Fracture-Dislocation with Displaced Femoral Neck Fracture ,[object Object],[object Object],[object Object]
Femoral Head Fracture-Dislocation with Non-Displaced Femoral Neck Fracture ,[object Object]
What if Reduction Maneuver Results in Displaced Femoral Neck Fracture?
Reduction Maneuver Results in Displaced Femoral Neck Fracture ,[object Object],[object Object],[object Object],[object Object]
Pipkin IV Fractures ,[object Object],[object Object],[object Object]
Many Options for Approach:
Femoral Head Fracture with Acetabulum Fractures Kregor, AAOS, 2004 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Questions? Return to Lower Extremity Index E-mail OTA about Questions/Comments If you would like to volunteer as an author for the Resident Slide Project or recommend updates to any of the following slides, please send an e-mail to ota @ aaos .org

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Hip Dislocations and Femoral Head Injuries

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  • 73. Pipkin, JBJS , 1957
  • 74. Pipkin I AO/OTA 31-C1.2
  • 75. Pipkin II AO/OTA 31-C1.3
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  • 85. Surgical Dislocation of the Hip for Fractures of the Femoral Head Helfet, Lorich et al, J Orthop Trauma , 2005
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  • 92. What if Reduction Maneuver Results in Displaced Femoral Neck Fracture?
  • 93.
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  • 95. Many Options for Approach:
  • 96.
  • 97. Questions? Return to Lower Extremity Index E-mail OTA about Questions/Comments If you would like to volunteer as an author for the Resident Slide Project or recommend updates to any of the following slides, please send an e-mail to ota @ aaos .org