Dislocation of the hip - Everything You Need To Know - Dr. Nabil Ebraheim
HTML-код
- Опубликовано: 1 янв 2018
- Dr. Ebraheim’s educational animated video describes types of hip dislocations.
Hip dislocation can be either a simple dislocation or it can be a fracture dislocation which involves the posterior wall of the acetabulum or the femoral head.
Dislocation of the hip can be two types:
1.Posterior dislocation (most common type)
2.Anterior dislocation (rare)
Position of the hip during the impact decides the injury.
In posterior dislocation of the hip, which is the most common type, the lower limb will be flexed, adducted and internally rotated.
Hip fractures are different than hip dislocations. Notice that the affected extremity is shortened and externally rotated with a hip fracture.
Hip dislocation of any type is an emergency. It must be reduced in less than 6 hours of injury. After reduction of the hip, get a CT scan. A CT scan clearly outlines the bony injury. Check the CT scan for congruous reduction, for the absence of fracture and absence of marginal impaction in the acetabulum. Marginal impaction is more common in posterior acetabular wall fractures and could lead to instability.
Displaced or comminuted posterior wall fracture could lead to arthritis. Make sure that you have a congruous reduction with no loose bodies or important fractures present. Check for fractures of the acetabulum and the size of the fragment. The size of the posterior wall fracture has an effect on the stability of the hip joint. If congruous reduction of the hip is not obtained, perform open reduction urgently. Open reduction can be done through an anterior approach or a posterior approach.
Hip dislocation with or without associated fracture can cause complications.The risk of avascular necrosis depends on the interval between the injury and reduction of the dislocation. Urgent reduction of hip dislocation is mandatory to avoid AVN and interruption of the blood supply which leads to collapse of the femoral head. Closed reduction should be done in less than 6 hours.
When injury occurs to the sciatic nerve due to posterior hip dislocation, the common peroneal nerve is usually affected, causing weakness in dorsiflexion of the ankle and loss of toe extension.
Injury to the sciatic nerve usually occurs from the dislocation and not from the reduction of the hip. The longer the wait for the reduction of the dislocation, the more the patient is predisposed to sciatic nerve injury. The length of time a hip remains dislocated influences the incidence and the severity of a major sciatic nerve injury.
Neurological examination at the time of injury is usually difficult, however it is extremely necessary. Check for sensation on the top of the foot.
In posterior dislocation of the hip, always look for injuries in the knee such as dashboard injury. The force of the injury is usually transmitted from the knee to the hip.
In cases of high energy trauma, always look at the chest. There might be a tear of the aorta. Check for widening of the mediastinum on chest x-rays. There is concern of deceleration injury involving the aorta.
Hip joint dislocation may be associated with acetabular fracture or fracture of the femoral head (Pipkin fracture). With Pipkin fracture, as the femoral head dislocated, it hits the posterior wall of the acetabulum and the femoral head fractures. This may be different from an anterior hip dislocation. Anterior hip dislocation will cause impaction of the femoral head or indentation fractures. Classically, Pipkin fracture is a posterior fracture dislocation of the hip and fracture of the femoral head.
Treatment of hip dislocation
•Emergency closed reduction of the hip within 6 hours.
•Closed reduction is done to avoid AVN of the hip.
•Reduction of the hip joint and mobilization of the patient with protected weight-bearing crutches for 4-6 weeks.
•After closed reduction, when the patient has an associated fracture, assess the ip stability
•The hip is usually stable if the fragment size of the acetabulum is less than 20% •More than 40 %, the hip is unstable. •Between 20-40% fragment size, the hip stability is undetermined.
When there is an associated acetabular fracture, the best method to assess the stability of the hip is by examination of the patient under general anesthesia utilizing fluoroscopy.
Assess the posterior wall stability with the obturator oblique view. Hip will be in flexion, adduction and add axial load. Check the medial clear space for opening.
Irreducible isolated posterior dislocation
•Do emergency surgical treatment to reduce the hip.
Treatment of posterior hip dislocation with posterior acetabular wall fracture
•Must assess the stability of the hip joint by examination under anesthesia after closed reduction.
•After closed reduction, if the dislocation is not congruent, do open reduction and fixation urgently.
Treatment of Pipkin femoral head fractures
•Headless screw fixation.
Oh my! Your videos are the best I've come across so far for med students doing ortho rotations. Thank you so much doc, God bless you. Love them. Excellently done
hello
Thank you so much Doc. Everytime I need a revision on any topic... I always know I can rely on your videos.
This video is very well done. Thanks for including advice on when to involve orthopedic and trauma specialists. The discussion of complications and their frequency is also welcome. Sometimes a subject is not as simple as it seems.
This was a very helpful summary of hip dislocation and fractures. Thank you very much for the video compilation.
Dr Nabil. Thank You for the Well Put together Video. You did an excellent presentation on this hip dislocation topic. All is needed now as an alternative if surgery is not recommended even to extents of future problems to occur of a suggested pain reliever method/s. Keep up the Excellent Job of what you been doing in Helping Many to a New Year of Good Health 😀
Very helpful Thank you Dr.Nabil
Thanks a lot for the detailed videos. I really appreciate your help!! A big salute!!!!
Excellent, informative indeed!!! Thanx Doc.
thank you soooo much you're helping aloooot of students worldwide 🌺🌱🍃🌷
I watch only your videos for ortho.They are the best.and you are an amazing teacher.Thank you for making orthopaedics easier💕💕💕🇳🇵
Thank you Doc!
This video helped me alot thank you doctor nabil
excellent teaching video. thanks.
Thank you Dr!
Very informative video
Thanks
thNks dr mabil
thank you doctor it was very useful lecture
Your videos are realy helpful...thnku so much
Thank you
Very helpful ❤️
برافو د نبيل تحياتي من مصر لحضرتك
Thank you sir
Very helpful for studying
Thank you dr.
Its very helpfull ,God bless you sir..💗
Very useful.....
Thk you doc
I like this vedeos Doctor, simple short and quality
Thanks...sir
I had an anterior hip dislocation and a femoral neck fracture from a violent motorcycle accident. It's been 3 1/2 months and I don't trust myself to walk normally with full weight bearing yet but am making progress. Stairs are still out of the question and I can't tie the shoe on my bad leg. Hoping that I can walk in the next month, several different pains in my hip when I walk but they go away when I sit down. Pool time has helped a lot.
Tieing your shoes may take awhile just like putting your pants on, without sitting down.
Omg going threw the Same thing now my surgery is in Hours am 24 years old
thanks for making orthopedics easier :)
Powerful
I have been suffering by this painful injury since childhood
I had total of almost 30 complete closes hip dislocations and 2 open dislocations, all in 10 months. I also had 5 major, multi day hospitals stays during the same 10 months. I had AVN and didn't know until i had the 1st surgery. I also had hypovolemic shock after 5th surgery.
I am afraid to have the other hip done
hi sir great lecture as always
but I have a question
if the luxation is posterior and the delay is longer than 24h what should we do ?
Thank you. Wht happens if a healthcare worker misses it for over 6 months ?
I love you so much
Very informative.... I don't know if I will get a reply but I have one the hips problem and it's starting to disturb me.. I need help and who to contact over there to know if it can be fixed
I have problem like that...how can i send my x rey to you...and can get suggesstion from you?
I have avascular necrosis 7months ago and until now I wasn't undergo surgery. how can effect this condition to my situation if i don't want to undergo the surgery? pls. help me.
This happened to me in a hang gliding accident 6/1/2019...posterior hip dislocation with fractured pelvis. I'm lucky, recovering well!
did you have a labral tear too?
Please suggest me what I can I do I am suffering from hip dislocation with fracture right now
Did you do surgery?
@@khydo yes couple plates few screws good
@@468cycle ahhhh
What if i dislocated my joint, and d
I did not fix it for 2 years?
Sir can you explain me in detail dislocation of hip my child from birth, not to stand self.
Sir please make all videos of anatomy of body
Halo,
I have a question
I have daughter 1.8 month already finish receive treatment open reduction pelvis ostetonomi. She already open the Spica cast and brace. But still use brace during sleeping
My question is there any case during your experience the hip joint unstable after conduct open reduction?
I'm still worry about my daughter condition
Hello,doctor my leg is the potions in 11 15 ,how do you think whats happening.
Sir how much time requires to plates to take out after ddh of 2 years baby plz reply sir
How can you solve it after three months
From curiosity, I think that I have a hip dislocation I cant sit with my left leg over my right knee, its rotated inside a bit and a bit shorter. So can anybody tell me something about that. Thank you
Firstly, ANY hip dislocation is an EMERGENCY... There's unbearable pain and the dislocation makes it impossible to carry out almost any movement of the affected joint.
Hip dislocation in adults cannot occur without a major traumatic accident. Nor can they remain calm enough to watch a youtube video and leave a neat reply😷 considering the excruciating pain they'll be dealing with.
Coming to your problem, it's necessary to first evaluate the exact nature of it.
Are you UNABLE to put your left leg over right knee or is it difficult but still possible?
Assessing your limb length discrepancy if there's any?
Since how long have you been experiencing this problem?
Assessing the movement range of your hip joint.
History of any trauma
etc
Limb length discrepancy can result from quite a few conditions during childhood.
Subluxation of hip is different from dislocation. Subluxation can only occur in early childhood when the hip joint is shallow & not fully developed. You might want to check it out as well to know what could be the lasting impacts of a subluxated hip joint.
Any abnormalities in the articular surfaces of the joint capsule can result in restriction and/or painful movements as well.
And the list goes on.
But rest assured, you can be certain of one thing ; you don't have a dislocated hip. 😷
Sir, why is the Common Peroneal nerve most affected in posterior dislocation given that the sciatic nerve doesn't divide at that level yet.
I'd like to know that too
The fibres of tibial are internal and and in centre.
The fibres of perineal are more lateral and outside, so foot drop occurs,
Trauma might be due to injection, dislocation, iateogenic,
Another reason is peroneal nerve supplies dorsiflexors so even if all fibres of sciatic are affected the foot drop is more prominent
Hope it helps
I feel n thought I dislocated my hip… I thinking it’s bruised after the video.. great job. My legs n hips look the same just hurt 😂
AUUUUGH Looks so painful
0:53 is it abducted or adduced
هايل
My hip hurts watching this because it was fractured in a car wreck. I’m trying to visualize how this happened to me
💖💖💖💖
এই সমস্যার চিকিৎসা কোথায় হবে আমার মেয়ের এই সমস্যা টি আছে ওর বয়স 1বছর 5 মাস আপনি যদি সাহায্য করেন
Treatment of Hip Dislocation by birth age 23 Years
when i was a baby, i had that.
oof. this make me worried
L
Thank you