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Anatomi

ANATOMY
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Femur connects to
acetabulum by 5
separated ligaments,
such as:
Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral ligament
transverse acetabular
ligament
femoral head ligament

DEFINITION & ETIOLOGY


Hip Joint dislocation is a situation where femoral

head locates out of the acetabulum


Causes trauma from high pressure or energy, such

as traffic accident and fall from significant


altitude

Posterior Dislocation
80-90% cases
Mostly because of Traffic accident
Pressure is trasmitted by 2 ways:

During high deceleration, knee hit


dashboard and distribute the pressure
through femur to hips
If the leg is extended and knee is locked,
the pressure can be distributed from
floorboard through thigh and lower of
hip joint
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type I dislocation is a pure

dislocation with at most an


insignificant posterior wall
fragment.
type II dislocation is
associated with a single large
posterior wall fragment
type III dislocation has a
comminuted posterior wall
fracture
type IV has an acetabular
floor (more than posterior
wall) fracture
type V dislocation is
associated with a femoral
head fracture

Gejala klinis

Hip joint in a state of flexion ,

adduction , and endorotasi .


The leg look shorter
Femur caput is palpabled in the
pelvis

Radiology Examination

On anteroposterior (AP)

photo, femoral head


seems located out from
acetabulum and placed
above it.
Oblique photo can be used
to measure fragment.
CT scan is the best way to
identify acetabulum
fracture and every bone
fragments.

MANAGEMENT
Must do repotition immediately. Closed reduction
can be done by a couple methods :Bigelow, Stimson,
dan Allis.
In type II after reposition, big fragment is fixated with
screw by surgery
In type III usually performs close reduction and
fragments that trapped in acetabulum will undergo
surgery
Type IV dan V reduction and surgery
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Stimson Methods
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Patients in the prone

position , lower limb trauma


left hanging
Pelvic immobilized by
pressing the sacrum
The left hand holds the
doctor ankle and flexion 90
Right hand holding down the
area below the knee
With the rocking motion and
rotation as well as direct
pressure to do repositioning

Bigelow Methods
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The patient in the supine

position on the floor


Doing the opposite
traction in the region
anterior superior iliac
spine and ilium
Legs flexed 90 or more
in the abdominal area
and carried out a
longitudinal traction

Allis Methods
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The patient in the supine

position
Doing pelvic immobilization
Flexion of the knee at 90
and legs diadduksi light and
medial rotation
Perform vertical traction
and femoral head is
removed from the posterior
part of the acetabulum
Hip and knee is extended
with caution

After open reduction, next step is apply traction on

the leg
Traction is being maintained for 3 weeks. Couple
days after reduction, active and passive movement of
the hip joint can be done
In the end of third week, patient is permitted to walk
using the kruk
Patient is allowed to lean on himself at the end of
week 12-14 and is permitted to do normal
activity 6-10 months after surgery

KOMPLIKASI
Ischiadicus nerve injury
Vascular injury. Sometimes there is ruptur on the

superior gluterus artery and bleeding may occur.


Corpus femoris fracture
If it happens at the same time with hip dislocation,
usually we missed the hip dislocation. So that we
have to do Xray examination for every femoral body,
trochanter and hip fractures

Avaskular Necrosis.
Avaskular necrosis is seen on X-Ray as increased

opacity femoral head, but this change cannot be


identified at least for 6 week, and sometimes more
(until 2 years), depends on how fast the bone is being
managed well.
Unreducted dislocation
After weeks, untreated dilocation rarely can be reducted
with closed manipulation and need open reduction
Osteoartritis
Secondary OA usually occurs and caused by (1)
destroyed cartilago when dislocated, (2) fragment
remains on joint (3) femoral head ischemic necrosis.

Anterior Dislocation

Anterior dislocation

Anterior dislocation is most often caused by

hyperextension pressure against the abducting leg


lifting the femoral head out of the acetabulum
Usually the lateral femoral head remains in the

external obturator muscle but can also be found


below ( obturator dislocation ) or under the iliopsoas
muscle in relation to the superior pubic ramus
( dislocation pubis ) .
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Classification anterior dislocation of the hip joint according to Epstein

Type I: Superior dislocations, including

pubic and subspinous


IA No associated fractures
IB Associated fracture or impaction of
the femoral head
IC Associated fracture of the acetabulum
Type II: Inferior dislocations, including

obturator, and perineal


IIA No associated fractures
IIB Associated fracture or impaction of
the femoral head
IIC Associated fracture of the acetabulum

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CLINICAL FINDING

Hip joint in a position

eksorotasi
Extension and abduction
There was no shortening
of the limbs
Where the femoral head
can be palpated easily in
front of the inguinal region
Hip joint difficult to move
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Pemeriksaan Radiologi

On the anteroposterior

photo , dislocations are


usually obvious , but
sometimes caput almost in
front of its normal position
so that if in doubt do the
lateral photo

CENTRAL DISLOCATION

Central Dislocation
The central dislocation is a fracture - dislocation , which

is caput femur is located on the medial acetabulum


fracture .

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Mechanism Of Injury

These dislocations can occur if someone falls from

height, falling one hand , or blow on the


trochanter major. This punch can push caput
femoris and the acetabulum base to cause fracture of
the acetabulum and pelvis .

Clinical Symptoms

The

position of the pelvis seemed normal


Bruises and abrasions lateral section
The movement of the hip joint is very limited

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Pemeriksaan Radiologi
On the anteroposterior photo , caput femoris

appears shifted to the medial and there is


fractures of the acetabulum floor

The patient was placed

in a supine position ,
then an assistant to
perform a lateral
traction , while
operators perform
longitudinal traction .

TREATMENT
Surgeons attractive with strong thigh and then bring out the head of

the thigh mengadduksi , use hard pads as a fulcrum .


If this method is successful, longitudinal traction is maintained
for 4-6 weeks with X - ray inspection to ensure that the caput
femoris remain under weight-bearing part of the acetabulum .
If manipulation fails , the combination of longitudinal and
lateral traction can reduce dislocation for 2-3 weeks .
On all of these methods , the movement needs to begin as soon as
possible .
When traction is removed , the patient is allowed to wake up with
the support of crutches (8weeks)

Indication of operation:

Acetabulum fracture with shift of > 2 mm in the

dome of the acetabulum .


Posterior wall fracture with > 50 % involvement
of the joint articulation surface on the posterior wall
Clinical instability in flexi 90 degree
Fragments stuck in the acetabulum after closed
reduction .
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Compliaction

Visceral injury and severe shock


Stiffness of joints , with or without osteoarthritis
Necrosis avaskular

PROGNOSIS

The prognosis of the hip joint

dislocation depending on :
The

damage other tissues


The initial management of dislocation
The severity of the dislocation

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