Round 3 Orthopedics (inpatient)

Hip dislocation ‫دي العناوٌن االساسٌة اللً اتقالت فً الراوند‬

 Introduction:-
Joint stability:-
 Joint stabilizers include:
o Active stabilizers:
 Strong muscles supporting the joint. (The active tension of muscles).
o Passive stabilizers: (anything but the active tension of muscles)
 Bony configuration
 Labrum
 Thick capsule
 Strong ligaments

‫ بتاعها‬tension‫ زي العضالت القوٌة وال‬active stabilizersً‫ ف‬.stabilizer ‫ بتاعت اي مفصل بتعتمد على كذا‬stability‫ٌعنً ال‬
‫ بتاعها زي شكل العضم المكون للمفصل وزي‬active tension‫ ودول اي حاجة غٌر العضالت وال‬passive stabilizers ً‫وف‬
.ligaments‫ وال‬labrum‫ وال‬capsule‫ال‬
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 The hip joint is a very stable joint. Hip joint stabilizers include:
o Active stabilizers:
 Strong muscles such as gluteal muscles, short external
rotators (attached to the capsule posteriorly) and
rectus femoris.
o Passive stabilizers:
 Deep acetabulum (bony configuration that favors
stability unlike the shoulder joint)
 Acetabular labrum (increases the depth of the
acetabulum)
 Thick capsule (parts of acetabulum) ‫هنحتاجها فً حاجات تحت‬
 Strong ligaments:
 Anteriorly → iliofemoral ligament (the strongest ligament in the body)
 Posteriorly → ischiofemoral ligament.

ً‫ وف‬deep ‫ بتبقى‬acetabulum‫ اللً حوالٌه وبسبب ان ال‬strong muscles‫ جدا جدا بسبب ال‬stable ‫ مفصل‬hip joint‫ال‬
‫ من‬femoral head‫ قدام تمنع ال‬iliofemoral ligament‫ ووجود ال‬thick capsule‫ اكتر وبسبب ال‬deep ‫ بٌخلٌها‬labrum
.‫ من ورا‬ischiofemoral ligament‫انها تطلع من قدام وال‬

N.B.:
Iliofemoral ligament (located anteriorly) is stronger than ischiofemoral ligament (located posteriorly)
so posterior dislocation is more common than anterior dislocation:
 Incidence of posterior dislocation is 80%-90%
 Incidence of anterior dislocation is 10%-15%
posterior ‫ اللً موجود ورا عشان كدا ال‬ischiofemoral ligament‫ اللً موجود قدام اقوى من ال‬iliofemoral ligament ‫ال‬
)%15-%19 ‫(بٌحصل بنسبة‬anterior dislocation‫) اشهر من ال‬%99-%8 ‫ (بٌحصل بنسبة‬dislocation

Blood supply of head and neck of femur:

Avascular necrosis is very common in case of hip dislocation so knowing the blood supply of
head and neck is very important. It's supplied by:
1) Medial circumflex femoral artery (posteriorly) (the main blood supply of head and neck)
2) Lateral circumflex femoral artery (anteriorly) (supplies less than the medial)
3) Superior and inferior gluteal arteries (medial ‫)بنسبة قلٌلة مش زي ال‬
4) Obturator artery
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 ً‫ من ورا دا االساس‬medial circumflex femoral artery‫ هو ال‬main blood supply of head and neck‫ال‬
superior and ‫ ومعاه‬medial‫ من قدام بس مش زي ال‬lateral circumflex femoral artery ‫وبٌساعده ال‬
.obturator artery ‫ بس بنسبة قلٌلة و‬inferior gluteal arteries
Course of the arteries:
The common iliac artery branches to external iliac artery that continues to be the femoral artery that
branches to femoral profunda (deep femoral artery) that branches to medial circumflex femoral
artery (posterior to the neck of femur) and lateral circumflex femoral artery (anterior to the neck of
femur). These 2 arteries wrap around the femoral neck forming a ring.

 Types of hip dislocation:- Dislocation

Congenital Acquired

Prosthetic Native
Posterior Central
Early Late Anterior
 Congenital dislocation (dislocation of neonates in the uterus during pregnancy)
 Acquired dislocation:
o Prosthetic dislocation: dislocation of prosthesis (hip arthroplasty prosthesis ‫)مثال‬. It doesn't
require violent injury. Classified to:
 Early dislocation: Happens within the first 3 months (which is more common), due to
patient not following precautions (and the soft tissue is still not completely healed in the
first 3 months) or incorrect positioning (malpositioning of prosthetic component)
(surgeon's fault)
 Late dislocation: prosthetic wear (‫)تآكل المفصل مع الوقت‬
o Native dislocation: dislocation of the original joint component that the patient was born
with. It requires violent injury (high force) because the joint is very stable. It's classified
(according to direction of force or direction of exit of the head of femur) to:
 Posterior dislocation (most common)
 Anterior dislocation (less common than posterior dislocation)
 Central dislocation (rare)
dislocation ‫ بٌحصل بعد الوالدة عادي واما ٌبقى‬acquired‫ بٌحصل للجنٌن وهو فً الرحم وال‬congenital‫ال‬
‫ شهور او‬3 ‫[ او بسبب ان المرٌض عمل حركة غلط فً اول‬late] ‫ مركبٌنها (بسبب ان المفصل تآكل‬prosthesis‫ل‬
‫ عالٌة‬force ‫ اللً اتولدنا بٌه ودي محتاجة‬native joint‫ لل‬dislocation ‫[) او انه‬early] ‫الجراح ركب المفصل غلط‬
.central‫ و‬anterior‫ و‬posterior‫ ل‬femoral head‫ ٌتخلع ودي بنقسمها حسب اتجاه خروج ال‬hip‫عشان ال‬
( ‫ اكثرهم حدوث‬posterior‫(ال‬
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 Posterior dislocation
- Most common (90% of dislocations) because
iliofemoral ligament (anterior) is stronger than
ischiofemoral ligament (posterior)
Description
Anterior dislocation
-Less common (10%-15% of dislocations)
because iliofemoral ligament (anterior)
is stronger than ischiofemoral ligament
(posterior)
- The femoral head is pushed out of the

socket in a forwards direction.

- The femoral head is pushed out of the socket
in a backwards direction. - Head can be palpated in femoral
triangle.
‫ اقوى من‬iliofemoral ligament‫النوع دا االكثر حدوثا عشان ال‬
‫ بتطلع لورا‬head‫ وفٌه ال‬.ischiofemoral ligament‫ال‬ iliofemoral ligament‫النوع دا اقل حدوثا عشان ال‬
head‫ وفٌه ال‬.ischiofemoral ligament‫اقوى من ال‬
.femoral triangle‫بتطلع لقدام ونقدر نحسها فً ال‬

Dashboard injury:- Obturator anterior Pubic anterior

A person is sitting in the front seat of a car (and
not wearing a seatbelt) and an accident Falling on the leg
while in flexion, Falling on the leg
occurred or the driver hit the brakes suddenly. while in extension,
abduction and
Mechanism of injury

If the airbag doesn't work, this person will abduction and

move forward hitting the dashboard of the car external rotation. external rotation.
and a force will be transmitted through the (the head is
(the head is pushed
shaft of femur causing posterior hip dislocation. pushed anterior + anterior + superior)
inferior)
‫ بتمنع انه ٌطلع لقدام لما العربٌة تتخبط فلو هو قاعد‬airbags‫ال‬ ‫لو وقع على رجله او‬
‫ مافتحتش او‬airbags‫قدام ومش البس الحزام والعربٌة خبطت وال‬ ‫لو وقع على رجله او‬
ً‫اتزحلق وفتح رجله ف‬ ً‫اتزحلق وفتح رجله ف‬
ً‫ الل‬dashboard‫السواق فرمل فجؤة ٌبقى هٌطلع لقدام وٌخبط ال‬ head‫الوضع دا ٌبقى ال‬
head ‫الوضع دا ٌبقى ال‬
.dislocation‫ هتعمل ال‬femur‫ هتعدي فً ال‬force ً‫قدامه وف‬ ‫هتطلع من قدام وفوق‬
‫هتطلع من قدام وتحت‬

 Patellar fracture (‫)اتخبط فٌها فاتكسرت‬

 PCL tear (excessive posterior translation of
tibia on femur)
)PCL‫ لورا فتقطع ال‬tibia‫(الخبطة تزق ال‬
 Femoral shaft fracture
 Fracture in shaft of femur (high force
transmitted through femur)  Femoral head and neck fracture
Associated injuries

 Fracture of femoral head and neck  Acetabular fracture

 Fracture of posterior wall of acetabulum.  (rare) Neurovascular injury (injury to
femoral vein, artery and nerve)
 Sciatic nerve injury (the nerve passes behind
the neck so when the head is pushed shaft, head ‫ سواء‬femur‫وارد انه ٌحصل كسر فً ال‬
backward it pushes the nerve, or when the ‫ انه ٌحصل‬rare‫ و‬.acetabulum‫ او ال‬and neck
posterior wall of acetabulum is fractured it femoral ً‫ بس لو حصل هٌبقى ف‬nerve injury
pushes on the nerve, or the surgeon injured .VAN
the nerve post reduction).
acetabulum‫ او ال‬nerve‫ خرجت لورا فتضغط على ال‬head‫(ال‬
‫اتكسرت فضغطت علٌه او الجراح ضغط علٌه وهو بٌعمل‬
)reduction

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 Thompson and Epstein classification system
I (simple) only dislocation, no fracture
Dislocation with fracture in posterior wall of
II
Classification
1) Obturator anterior (inferior anterior)
2) Pubic anterior (superior anterior)
The obturator foramen is located under the
pubic bone so if the femoral head is pushed
forward (anterior) and superiorly then it's
called pubic anterior dislocation and if it's

acetabulum
pushed forward (anterior) and inferiorly
Dislocation with comminution of acetabular then it's called obturator anterior
III dislocation.
ring
Obturator anterior is less common
IV Dislocation with fracture of acetabular floor pubic ‫ طلعت لقدام ولفوق ٌبقى راٌحة ناحٌة ال‬head‫لو ال‬
‫ ولو طالعة لقدام ولتحت‬pubic anterior ‫ فنسمٌها‬bone
Dislocation with fracture of femoral head and ‫ ٌبقى نسمٌها‬obturator foramen‫ٌعنً ناحٌة ال‬
V neck .obturator anterior

 Affected leg is shorter

Appearance of limb

Limb in flexion, Limb in extension,

 Limb is in flexion, adduction and internal abduction and abduction and
rotation. external rotation. external rotation.

‫ زي اللً مكتوب النه ممكن ٌبقى‬appearance‫ وارد جدا ماشوفش ال‬fracture‫ زي ال‬associated injuries ‫لو العٌان عنده‬
.angulation ‫ او‬rotation ‫ وحصل‬fracture in femoral shaft ‫حصل‬

 Late arthritis (very common)

Complications

 Avascular necrosis: (main blood supply is

located posteriorly) (very common)  Avascular necrosis:
posterior dislocation‫(بٌحصل بس بنسبة اقل من ال‬
 Late arthritis (post-traumatic) (secondary)
)‫ موجود ورا‬main blood supply‫الن ال‬

Thompson and Epstein's classification system (posterior dislocation)

Dashboard injury Posterior dislocation Anterior dislocation

(Limb appearance) (Limb appearance)

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N.B.:
 It's very common for a violent injury like hip dislocation to cause associated injuries such
as fractures in femur or acetabulum (simple pure injury is less common than complex
injury with associated injuries)
 Dashboard injuries are most common mechanism of injury.
 Internal rotation causes posterior dislocation, external rotation causes anterior dislocation.

Central dislocation:- (Very rare)

 Central penetration (migration) of femoral head into acetabulum (‫)تدخل لجوا‬
 Most common mechanism of injury to cause central dislocation is direct axial force (hip in
abduction and a direct axial force or load pushed the head medially into the acetabulum)
 Associated injuries: (very common) fracture of superior dome of acetabulum and femoral
fractures.
 Management of central dislocation is according to the extensive injury:
o If the head just migrated centrally without fracture, the patient will be put on skeletal
traction for 3 weeks (conservative)
o If the head migrated centrally and caused acetabular fracture (extensive ‫)بس بسٌط مش‬,
open reduction, internal fixation is performed (ORIF)
o If the head migrated centrally and caused extensive fracture in acetabulum, total hip
arthroplasty is performed.
fracture of ‫ لجوا ووارد جدا ٌحصل‬medially ‫ زقتها‬direct axial forceً‫ لو ف‬acetabulum‫ لجوا ال‬head‫بتدخل فٌها ال‬
‫ بس ومافٌش كسر ٌبقى‬dislocation ‫ للحالة ٌعنً لو‬according ‫ وٌتعاملو معاها‬.femoral fracture‫ و‬acetabulum
‫ ولو الكسر كان جامد‬open reduction, internal fixation ‫ اسابٌع ولو حصل كسر بسٌط ٌبقى‬3 ‫ لمدة‬skeletal traction
.total hip arthroplasty ‫ٌبقى نعمل‬

Surgical management:-
 Complete survey:
In case of a violent injury like hip dislocation, a complete survey will show the surgeon if there
are any associated injuries in the epsilateral or contralateral limb and whether the surgeon
will perform closed or open reduction (because we can't perform a closed reduction if there
are any associated injuries like fractures in the epsilateral limb even if the fracture isn't
displaced). A complete survey includes:
o History
o Appearance of the limb
o Radiology
o Neurovascular examination

‫ وال أل النه لو فً مش هٌنفع‬dislocation‫ هٌعرف الجراح هل فً اي اصابات او كسور مع ال‬complete survey‫ال‬

‫ شكله عامل اٌه ونعمل‬limb‫ ونبص على ال‬history‫ فبناخد منه ال‬.displacement ‫ حتى لو ماحصلش‬closed ‫نرده‬
‫ اللً محتاجٌنها‬neurovascular examinations‫االشعة وال‬
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 History:
o Ask if the patient has prosthesis (to know if the dislocation is native or prosthetic)
o If the patient has prosthesis, ask when he had the surgery (to know if the dislocation is
early or late)
o Ask about the incision site of the surgery (to know if the surgery is of posterolateral,
lateral or anterolateral approach [it's more likely that he will do open reduction from the
same site])
o If it's not a prosthetic dislocation then it's native of course and we continue the survey.
late ‫ ولو مركب نسؤله ركبه امتى عشان نعرف‬prosthetic ‫ وال‬native ‫ٌعنً نسؤله مركب مفصل وال أل عشان نعرف هو‬
‫ فً العملٌة ولو مش مركب حاجة ٌبقى دا‬approach ‫ عشان نعرف هو عامل اي‬incision site‫ ونسؤله عن ال‬early ‫وال‬
.survey ‫ ونكمل ال‬native

 Appearance of the limb:

o The appearance will help us know if the dislocation is posterior or anterior:
 Posterior dislocation → limb is short and in flexion, adduction and internal rotation.
 Obturator anterior dislocation → limb in flexion, abduction and external rotation.
 Pubic anterior dislocation → limb in extension, abduction and external rotation.
o But in case of any associated the limb may appear different from the previous description
because of displacement or angulations.
limb‫ شكل ال‬associated injuries ً‫ اللً حصل ولو ف‬dislocation‫ اٌه عشان نحدد نوع ال‬limb‫ٌعنً بنبص شكل ال‬
.angulation ‫ او‬displacement ‫مش هٌبقى زي الوصف دا بالظبط بسبب انها الكسر عمل‬

 Radiology:
o X-ray (AP and lateral)(hip profile):
 To confirm diagnosis, direction of dislocation and any associated injuries like fractures.
 How to differentiate between anterior and posterior dislocation in X-ray film?
 In anterior view, The X-ray machine is usually put in front of the patient and
normally, the 2 femoral heads should have the same size.
 So if one femoral head is pushed anteriorly (anterior dislocation), this means that the
distance between the head and the machine is smaller, so this head will appear
bigger than the other normal head.
 And if one femoral head is pushed posteriorly (posterior dislocation), this means that
the distance between the head and the machine is bigger, so this head will appear
smaller than the other normal head.
 There is also other landmarks we look at to detect rotation of the limb such as the
lesser trochanter (‫)شاٌفٌنها فً االشعة وال أل‬
o CT scan:
 To detect loose fragments in the joint.
anterior ‫ وال‬posterior ‫ فنعرف ازاي ان دا‬.‫ فً اي اتجاه ونشوف لو فً اصابات تانٌة‬dislocation‫ عشان نشوف ال‬X-ray ‫بنعمل‬
posterior ً‫ اصغر ٌعنً بعٌدة لورا ٌعن‬head‫ ولو ال‬anterior dislocation ً‫ اكبر من التانٌة ٌعنً مقربة ٌعن‬head‫؟ لو ال‬dislocation
‫ عشان‬CT scan ‫ ونعمل‬.‫ وال أل‬angulation ‫ هل شاٌفٌنها وال أل عشان نحدد حصل‬lesser trochanter ‫ وممكن نبص على‬.dislocation
‫ فً المفصل وال أل‬loose ‫نشوف هل فً حاجة‬
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 Neurovascular examination:
o To detect avascular necrosis.
o To detect nerve injury. Common Sciatic nerve injury manifestations are:
 Drop foot.
 Affected sensation in dorsum of foot.

.open or closed reduction ‫ بٌكون معانا معلومات تساعد الجراح ٌقرر هٌعمل‬complete survey‫بعد ال‬

Reduction:
 Open reduction:
o Open reduction is indicated in case of:
 Prolonged time since dislocation (being a time sensitive injury means that reduction
must be performed as soon as possible in order to avoid avascular necrosis, but if
prolonged time had passed then open reduction is indicated)
 In case of associated injuries (such as fractures of femoral shaft, head, neck or
acetabulum even if the fracture isn't displaced)
 Failed closed reduction (due to soft tissue interposition, which means that parts of
the capsule, labrum or muscle got detached and entered the joint space)
 Recurrent dislocation (a previous dislocation caused persistive instability causing
more dislocations)
 Prosthetic dislocation (due to incorrect positioning of prosthetic component or
mechanical loosening. So the surgeon must open and put prosthesis in accurate
position)

o In case of prosthetic dislocation, open reduction is done from the same incision site.
o In case of native dislocation, some surgeons prefer to do the incision in the direction of
the exit of the femoral head from the acetabulum (which means the surgeon performs
posterolateral approach [posterolateral incision] in case of posterior dislocation and
anterolateral in case of anterior dislocation) to avoid avascular necrosis because if the
dislocation already injured the arteries in one side, why damaging arteries of the other
side by performing the surgery in different direction of the exit of the head. But some
researches proved that it has no such effect and doesn't cause avascular necrosis so it's
up to the surgeon and what incision site the surgeon prefers.

‫ فً اقرب‬dislocation‫ النه كان المفروض ٌترد بعد ال‬dislocation‫؟ لو عدى وقت طوٌل على ال‬open reduction ‫امتى ٌعمل‬
closed ‫ ولو عمل‬.displacement ‫ حتى لو ماحصلش‬dislocation‫وقت ممكن ولو فً اي اصابات او كسور تانٌة مع ال‬
‫ كتٌر بسبب انه عنده‬dislocation ‫ ولو بٌحصله‬.‫ متجمع جوا المفصل‬soft tissue ً‫ بس مانفعش عشان ف‬reduction
.‫ ٌعنً فكت‬loosening ‫ اتحركت من مكانها وتخلعت او حصلها‬prosthesis‫او انه ال‬.‫ مستمرة وبٌتخلع كتٌر‬instability

‫ ٌبقى فً جراحٌن بٌفضلو ٌعملو من‬native ‫ ولو‬incision site‫ ٌبقى الجراح هٌفتح من نفس ال‬prosthetic dislocation ‫لو‬
‫ لٌه فً الجمب‬damage‫ النه خالص لو فً جانب متؤثر اعمل‬avascular necrosis‫ عشان نتجنب ال‬head‫نفس اتجاه خروج ال‬
.‫ من قدام وورا متؤثر؟ ولكن فً ابحاث بتقول انه الموضوع دا مابٌاثرش وعلى حسب تفضٌل الجراح‬blood supply‫التانً وٌبقى ال‬

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 Closed reduction under sedation:
o Closed reduction is indicated if the X-ray showed that there is no condition requiring
open reduction.
o It must be under sedation so that the muscles are relaxed (if the muscles are tensed, the
protective action will make the reduction fail) or the patient may push the surgeon due to
severity of the pain.
o There are several reduction techniques such as Allis maneuver for posterior dislocation
reduction.
o After closed reduction, X-ray is performed to make sure that the reduction is successful
and no nerve injury occurred during reduction, then a CT scan is performed.
‫ والزم العٌان ٌبقى متخدر عشان العضالت تبقى مرٌحة النها لو‬closed ‫ ٌبقى نعمل‬closed reduction‫لو مافٌش حاجة تمنع ال‬
.‫ صح والوجع اصال ٌخلً العٌان ٌزق الدكتور‬reduction ‫ تعٌق الدكتور انه ٌعمل‬protective action ‫مش مرٌحة ٌبقى هتعمل‬
.CT scan ‫ وبعدها نعمل‬. nerve injury‫ نتؤكد انه كله تمام وماحصلش‬X-ray ‫ بنعمل‬reduction‫ وبعد ال‬technique ‫وفً كذا‬

PT role post-reduction:-

‫ كل شخص ورأٌه‬option ‫ علٌه وفً كذا‬debate ً‫ فف‬physical therapy role after reduction ‫بالنسبة لل‬
.‫وتفضٌله حسب اللً شاٌفه فً حالة المرٌض‬
 In case of simple injury with closed reduction:
o Immobilization options:
 Avoid extensive motion up to 1-1.5 months to prevent dislocation and the surgeon
choose either of the following options:
1) The 1st option is Traction for 3-4 weeks to avoid avascular necrosis. In this case the
physical therapist deal with the patient normally as a patient on traction and after
the removal of traction we resort to ROM exercises, joint mobilization, strengthening
of muscles around the hip and proprioceptive training.
2) The 2nd option is Early mobility because immobility would cause adhesion. In this case
the physical therapist resort to joint mobilization, strengthening of muscles around
the hip.
 We look at the patient's imaging to detect whether the patient is predisposed to
dislocation or not. If the patient is predisposed, the traction option is more suitable. If
not, the early mobility option is more suitable.
o Weight bearing:
 Avoid extensive motion up to 1-1.5 months to prevent dislocation and the decision of
weight bearing is always the surgeon's decision (‫)زي ماقولنا قبل كدا عشان لو حصل مشاكل ماٌبقاش اللوم علٌك‬

‫ وال ٌمشٌه من بدري واٌا‬traction ‫ تانً وال أل وعلى اساسه ٌشوف ٌحطه على‬dislocation ‫الجراح بٌشوف العٌان وارد ٌحصله‬
‫ عشان خاٌف لو‬traction ‫ ولو الجراح قرر انه هٌعمل‬dislocation ‫كان قرار الجراح الزم اتجنب اي حركة عنٌفة عشان ماٌحصلش‬
‫ عادي زي ماخدنا الترم اللً فات فً الراوند‬traction ‫ ٌبقى هنتعامل معاه كعٌان على‬avascular necrosis ‫العٌان اتحرك ٌحصل‬
‫ ولو الجراح قرر انه هٌمشً العٌان من بدري عشان خاٌف ان‬strengthening‫ و‬ROM ‫ نعمله تمارٌن زي‬traction‫ولما نشٌل ال‬
‫ فزي ماقولنا دا قرار‬weight bearing‫ وبالنسبة لل‬.strengthening ‫ ٌبقى هنعمله تمارٌن زي‬adhesion ‫ تعمل‬immobility‫ال‬
.‫الجراح عشان لو حصل مشاكل ماٌبقاش اللوم علٌك وهو الجراح عارف عمل اٌه فً العملٌة وعلى حسب قراره هنتعامل معاه‬

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 In case of complex injury with open reduction:
o There is the same debate about immobilization and weight bearing options and it's up to
the surgeon to decide and we will deal with the patient according to the decision of the
surgeon.
o In case of complex injuries, there are other associated injuries (like fractures or ligaments
injuries) we should consider while dealing with the patient. For example in case of
fracture in femoral shaft and the surgeon fixed it with internal fixation:
 If the surgeon inserted plate and screw, the patient will be immobilized for 3
months.
 If the surgeon inserted unlocking intramedullary nail, the patient will walk non-
weight-bearing for 1.5 months then partial weight-bearing 20%-25% according to
the nail diameter and increase the weight-bearing 5-10 Kg every week. After 3
months, the patient will be walking full weight-bearing.
o We also deal with the patient according to incision site. For example if the surgeon did a
postero-lateral incision, we deal with the patient with the same precautions and program
of postero-lateral incision (as discussed in round 1, avoid hyperflexion, adduction,
internal rotation…etc) and same thing goes for lateral and anterolateral incisions
(avoiding external rotation….etc). In case of hip resurfacing, the precautions are the
precautions of all incision sites (avoiding both internal and external rotation) because it's
an extensive incision.

‫ بردو قرار الجراح بس نراعً ان بٌبقى المرٌض عنده اصابات تانٌة نتعامل‬weight-bearing‫ وال‬immobilization‫ال‬
‫ ٌبقى نتعامل‬posterolateral incision ‫ اللً الدكتور عملها ٌعنً لو عمل‬incision ‫معاه على اساسها وعلى حسب ال‬
‫ اللً شوفناه فً اول راوند ونفس‬posterolateral incision ‫ بتاع ال‬program ‫ وال‬precautions‫معاه بنفس ال‬
‫ هتبقى بتاعت كله سواء‬precautions‫ ٌبقى ال‬hip resurfacing ‫ ونراعً انه لو عامل‬incisions‫الشًء لباقً ال‬
.posterior approach ‫ او ال‬anterior approach ‫ال‬

‫ رجله‬limb appearance‫ (ال‬posterior dislocation ‫ لعٌان عنده‬Allis maneuver ‫الدكتور عرضت فٌدٌو فٌه‬
‫ فعشان كدا قرر انه هٌعمله‬femur‫ فً ال‬fracture ‫) وماعندوش‬flexion, adduction, internal rotation ً‫داخلة ف‬
traction, extension, external ‫ هٌعمل‬reduction ‫ والناس بتثبت العٌان والجراح بٌعمل‬closed reduction
fractured ‫ لقاه ماتردش مظبوط وشاكك ان فً جزء‬... ‫ تانٌة عشان ٌتؤكد اترد وال أل‬X-ray ‫ وبعدها ٌعمل‬rotation
.open reduction ‫ عشان ٌتؤكد ولو كدا ٌبقى هٌعمل‬CT ‫ فهٌعمل‬joint‫ فً ال‬loose ‫موجود‬

‫لٌنك الفٌدٌو اللً الدكتور عرضته موجود فً البوست اللً نازل فٌه الملخص‬

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