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Description: images-1
Posterior dislocation: Shortening and FADIR deformity.
Central dislocation: Shortening and PR femoral head palpation
Anterior dislocation: Lengthening and FABER deformity.
Anterior dislocation: Lengthening and FABER deformity.

Important Point

  1. Posterior Dislocation Of Hip
    1. It is most common type of hip dislocation in adults and children.
    2. Usually this occurs in a road accident when someone seated in car is thrown forwards, striking the knee against the dashboard (dashboard injury).
    3. It is the position (direction) of hip at the time of injury that decided the pattern of injury.

Position of Hip at the time of Injury

Patter of Injury

Flexion, adduction, internal rotation

Pure posterior dislocation

Less flexion, less adduction (neutral or slight abduction), internal rotation

Posterior fracture dislocation

Hyper abduction + Extension

Anterior dislocation

  1. Classification Schemes For Posterior Hip Dislocations
    1. Thompson & Epstein
      1. Type I Dislocations without or with minor fracture
      2. Type II Dislocation with a single large fracture of posterior acetabular rim.
      3. Type III Dislocation with comminution of posterior acetabular rim.
      4. Type IV Dislocation with fracture of acetabular floor.
      5. Type V Dislocation with fracture of femoral head
    2. Thompson & Epstein is subdivided by pipkin into four types (Pipkin classification)
      1. Type 1 Femoral head fracture caudal to fovea centralis
      2. Type 2 Femoral head fracture cephalad to the fovea
      3. Type 3 Femoral head fracture associated with femoral neck fracture
      4. Type 4 Type I, II or III with associated acetabular fracture
    3. In posterior dislocation of hip clinical presentation is
      1. Flexion, adduction and internal (medial) rotation deformity with shortening
      2. Femoral head can be palpated posteriorly
      3. Vascular sign of Narath is positive i.e. due to posterior dislocation of hip joint the vessels fall back unsupported so femoral arterial pulsation, which is felt against the head of the femur will be feeble or even may not be palpable.
      4. Due to posterior direction of displacement sciatic nerve and superior gluteal artery injury may occur.
      5. It is the posterior dislocation that cause maximum shortening of limb and is most commonly associated with sciatic nerve injury
      6. Simple dislocations are mostly managed by close reduction under anesthesia. Few methods of reduction are — Stimsons gravity method, Allis maneuver, Bigelow maneuver and East Baltimore lift.

Anterior Dislocation of Hip

  1. Mechanism of Injury
    1. Deceleration injury in which occupant is in relaxed position during impact with the limb flexed, abducted & externally rotated.
    2. Motor cycle accidents in which hip is hyperabducted & externally rotated.
    3. The degree of hip flexion at the time of injury determines the eventual position of femoral head, with extension leading to superior pubic dislocation and flexion resulting in an inferior obturator dislocation
  2. Clinical Presentation
    1. According to the position assumed by femoral head it is classified as: pubic, obutrator, or perineal
    2. At presentation, the lower extremity is externally rotated, abducted and extended (pubic dislocation) or flexed (obturator dislocation)
    3. Because of anterior direction of displacement, femoral vessels and nerve may be injured, especially with pubic dislocations.
    4. Extremity may appear longer.

Central Dislocation

In central fracture dislocation of hip, femoral head is forced medially through the floor of acetabulum and can be palpated on per rectal examination
  1. Clinical Presentation & Characteristic Deformities In Hip Dislocation
    1. Anterior dislocation
      1. Extremity may appear longer
      2. Femoral nerve may be damaged
      3. External rotation, Abduction
      4. Flexion (in obturator type)
      5. Extension (in pubic type)
    2. Posterior dislocation
      1. Flexion, Adduction and Internal rotation with shortening
      2. Sciatic nerve may damage
  2. Central Dislocation
    1. The leg does not rest in a characteristic position and the leg length is similar to that of the opposite leg. There may be some narrowing of pelvic width
    2. Femoral head can be felt on PR examination.

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