Dislokasi Hip 2

7/26/2019 Dislokasi Hip 2

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Anatomi



ANATOMY

Femur connects toacetabulum by 5separated ligaments,such as:

Iliofemoral ligament Pubofemoral ligament

Ischiofemoral ligament

transverse acetabular

ligament

femoral head ligament

2



DF!N!T!ON " T!O#O$Y

%ip &oint dislocation is a situation 'here femoralhead locates out of the acetabulum

(auses

trauma )rom high pressure or energy, suchas traffic accident and fall )rom signi)icantaltitude

*



Posterior Dislocation

+-./ cases

Mostly because o) Tra))ic accident

0ressure is trasmitted by 2 'ays: During high deceleration, knee hit

dashboard and distribute the pressurethrough )emur to hips

!) the leg is e1tended and nee is loced,

the pressure can be distributed )romfloorboard through thigh and lo'er o)hip 3oint

4



type ! dislocation is a puredislocation 'ith at most aninsigni)icant posterior 'all

)ragmenttype !! dislocation isassociated 'ith a single largeposterior 'all )ragment

type !!! dislocation has acomminuted posterior 'all)racture

type !6 has an 7acetabular)loor8 9more than posterior

'all )racturetype 6 dislocation isassociated 'ith a )emoralhead )racture



$e3ala linis

%ip 3oint in a state o) flexion ,adduction , and endorotasi

The leg loo shorterFemur caput is palpabled in the

pel;is



<adiology 1amination

On anteroposterior 9A0photo, femoral headseems located out fromacetabulum and placed

above itObli=ue photo can be used

to measure )ragment

CT scan is the best 'ay toidenti)y acetabulum)racture and e;ery bone)ragments



MANA$MNT

Must do repotition immediately Closed reductioncan be done by a couple methods :>igelo', ?timson,dan Allis

!n type !! a)ter reposition, big )ragment is )i1ated 'ithscre' by surgery

!n type !!! usually per)orms close reduction and)ragments that trapped in acetabulum 'ill undergo

surgery Type !6 dan 6 reduction and surgery

.



?timson Methods

0atients in the proneposition , lo'er limb traumale)t hanging

0el;ic immobili@ed bypressing the sacrum

The le)t hand holds thedoctor anle and )le1ion .

<ight hand holding do'n the

area belo' the nee Bith the rocing motion and

rotation as 'ell as directpressure to do repositioning

C



>igelo' Methods

The patient in the supineposition on the )loor

Doing the opposite

traction in the regionanterior superior iliacspine and ilium

#egs )le1ed . or more

in the abdominal areaand carried out alongitudinal traction

CC



Allis Methods

The patient in the supineposition

Doing pel;ic immobili@ationFle1ion o) the nee at .and legs diaddusi light andmedial rotation

0er)orm ;ertical tractionand )emoral head isremo;ed )rom the posteriorpart o) the acetabulum

%ip and nee is e1tended 'ith caution

C2



A)ter open reduction, ne1t step is apply traction onthe leg

Traction is being maintained )or 3 weeks (ouple

days a)ter reduction, acti;e and passi;e mo;ement o)the hip 3oint can be done

!n the end o) third 'ee, patient is permitted to 'alusing the kruk

0atient is allo'ed to lean on himself at the end o) week 121! and is permitted to do normalactivity "1# months a)ter surgery



OM0#!A?!

$schiadicus nerve in%ury

&ascular in%ury ?ometimes there is ruptur on thesuperior gluterus artery and bleeding may occur

Corpus femoris fracture!) it happens at the same time 'ith hip dislocation,

usually 'e missed the hip dislocation ?o that 'eha;e to do Eray e1amination )or e;ery )emoral body,

trochanter and hip )ractures



'vaskular (ecrosis

A;asular necrosis is seen on E-<ay as increasedopacity )emoral head, but this change cannot beidenti)ied at least )or 'ee, and sometimes more9until 2 years, depends on ho' )ast the bone is beingmanaged 'ell

)nreducted dislocation A)ter 'ees, untreated dilocation rarely can be reducted

'ith closed manipulation and need open reduction

*steoartritis

?econdary OA usually occurs and caused by 9Cdestroyed cartilago 'hen dislocated, 92 )ragmentremains on 3oint 9* )emoral head ischemic necrosis



'nterior Dislocation



Anterior dislocation

Anterior dislocation is most o)ten caused byhypere1tension pressure against the abducting leg

li)ting the )emoral head out o) the acetabulum

Gsually the lateral )emoral head remains in thee1ternal obturator muscle but can also be )ound

belo' 9 obturator dislocation or under the iliopsoasmuscle in relation to the superior pubic ramus9 dislocation pubis

CH



(lassi)ication anterior dislocation o) the hip 3oint according to psteinType I: Superior dislocations, including

pubic and subspinous IA No associated fractures

IB Associated fracture or impaction ofthe femoral head

IC Associated fracture of the acetabulum

Type II: Inferior dislocations, includingobturator, and perineal

IIA No associated fractures IIB Associated fracture or impaction of

the femoral head

IIC Associated fracture of the acetabulumC+



(#!N!(A# F!ND!N$

%ip 3oint in a positionesorotasi

1tension and abduction

There 'as no shorteningo) the limbs

Bhere the )emoral head

can be palpated easily in)ront o) the inguinal region

%ip 3oint di))icult to mo;e

C.



0emerisaan <adiologi

On the anteroposteriorphoto , dislocations are

usually ob;ious , butsometimes caput almost in)ront o) its normal positionso that i) in doubt do the

lateral photo



C+(-'. D$/.*C'$*(



Central Dislocation

The central dislocation is a fracture dislocation , 'hichis caput )emur is located on the medial acetabulumfracture

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Mechanism O) !n3ury

These dislocations can occur i) someone falls fromheight, falling one hand , or blow on the

trochanter ma%or This punch can push caput)emoris and the acetabulum base to cause )racture o)the acetabulum and pel;is



(linical ?ymptoms

The position o) the pel;is seemed normal0ruises and abrasions lateral sectionThe mo;ement o) the hip 3oint is ;ery limited

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0emerisaan <adiologi

On the anteroposterior photo , caput )emorisappears shifted to the medial and there isfractures of the acetabulum floor



The patient 'as placedin a supine position ,

then an assistant toper)orm a lateraltraction , 'hileoperators per)orm

longitudinal traction



T<ATMNT

?urgeons attracti;e 'ith strong thigh and then bring out the head o)the thigh mengaddusi , use hard pads as a )ulcrum

!) this method is successful, longitudinal traction is maintained

)or 4- 'ees 'ith E - ray inspection to ensure that the caput)emoris remain under 'eight-bearing part o) the acetabulum

!) manipulation fails , the combination o) longitudinal andlateral traction can reduce dislocation )or 2-* 'ees

On all o) these methods , the mo;ement needs to begin as soon as

possible Bhen traction is remo;ed , the patient is allo'ed to 'ae up 'ith

the support o) crutches 9+'ees



!ndication o) operation:

'cetabulum fracture 'ith shi)t o) I 2 mm in thedome o) the acetabulum

Posterior wall fracture 'ith I 5 / in;ol;emento) the 3oint articulation sur)ace on the posterior 'all

(linical instability in )le1i . degree

ragments stuck in the acetabulum a)ter closed

reduction

2+



(ompliaction

6isceral in3ury and se;ere shoc

?ti))ness o) 3oints , 'ith or 'ithout osteoarthritis

Necrosis avaskular



0<O$NO?!?

The prognosis o) the hip 3oint

dislocation depending on :The damage other tissuesThe initial management o) dislocationThe se;erity o) the dislocation

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Dislokasi Hip 2

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