Hip Dislocation & Femur neck Fracture

Hip Dislocation & Femur neck Fracture

Dr. Wahby Ghalib CABMS, FJMC, MRCS

Hip dislocation

Posterior 75% Anterior Central

Posterior dislocation

Dash-board injuryLeg shortened, adducted internally – rotated & slightly flexed

Classification (Epstein)

I : + chip # of the acetabulum II : + large fragment III : + comminuted acetabular # IV : + # of the floor of the acetabulum V : + femur head #


Rx
CR + traction 4w OR indicated in : failed CR type II fragment entrapped in joint



Early Cx
Sciatic nerve injury : 10-20 %Vascular injury : superior glutealFS #  missed dislocation

Late Cx

AVN OA Myositis ossificans Recurrent dislocation

Femur Neck #

Risk factor
osteoporosis

OA is protective

Mechanism
Fall on greater trochanter Fall from a height



CF
When displaced leg is shortened & externally rotated

Classification (Garden)

I : incomplete # II : complete undisplaced III : complete + moderate displacement IV : complete + severe displacement

Blood supply of femur head

Intramedullary vessels Capsular vessels Vessels of ligamentum teres

FN # has poor healing potential because it is intraarticular #

Flimsy periosteumCapsular vessels torn by #Intracapsular haematoma  tamponade effectSynovial fluid  haematoma will not clot

FN # can be missed :

Stress # Impacted # Garden`s II # Debilitated pt Multiple #s


Rx
< 60 yr  CR or OR + IF> 70 yr  PHR60 – 70 yr  CR + IF if fails  PHR



Cx
AVN 10 % in type I &II 30 % in type III & IV Nonunion OA

Objectives :

Stressing the importance of hip fractures taking into account their high incidence and significant mortality and morbidity. Stressing the significance of time factor in the management of hip injuries.

Objectives :

Stressing the importance of medical perioperative care of victims of hip fractures being elderly with multiple medical conditions. Understanding the basic principles of management hip fractures. Understanding the importance of prevention and treatment of osteoporosis in hip fractures.