Hip dislocation occurs in about 10% of all dislocations. It depends on the position of the head facing the front or back of the acetabulum (acetabulum), hip dislocation is divided into front and rear. Depending on the high or low state of the head, both of these kinds of hip dislocations More divided into upper and lower.
Hip dislocation origin is divided into:
- dislocations from flexion and adduction, and from flexion and abduction
- dislocations from extension and retraction
From instrumental methods of diagnosis of hip dislocation doctor may be appointed and held the following diagnostic procedures:
- CT scan of the hip joint (computed tomography)
- MRI of the hip joint (magnetic resonance imaging)
- X-rays of the hip joint (arthrography)
Posterior hip dislocation
Posterior dislocation - these are the most frequent (80% of all dislocations) hip. When rolling the physiological border sudden flexion, adduction and rotation of the leg into the femoral neck rests on the anterior edge of the acetabular fossa. Education is the pivot point created double-arm lever, the short end of which - articular head - very annoying and breaks the back, badly fortified part of the joint capsule. Unless of course at the strengthened enforcement and rotation (rotation) is bent into a right angle is less, it is obtained with a dislocated tendon rupture the bag over. When the hip flexion greater than a right angle is a dislocation with a break bags and head for the release of the tendon. This position of the head can be changed - if the ongoing violence - in the form of rotation (rotation) into the thigh. In general, the articular head is lower, the stronger was the original bend and the lower back is broken capsule.
Posterior hip dislocation symptoms
At dislocation the leg is reduced, slightly bent at the hip and knee joints, sharply unscrewed (rotated) inside and is spring resistance when trying to straighten the hip or knee. Rotisserie (trochanter) is above-Nelatonovskoy Roser (Roser-Nelaton) line and in front of the middle of it. The head joint of the femur at thin can easily be probed in the gluteal region. Sometimes there are disorders of the sciatic nerve (n. Ischiadici) on the side of hip dislocation.
Anterior hip dislocation
Anterior dislocation is possible to obtain in the experiment on the body during the forced abduction with rotation (rotation) outwards and extension. In life, these dislocations are obtained, for example, a fall from a height on the legs apart from the tilting of the body back, the lower edge of the glenoid fossa is thus the fulcrum of the femoral neck, and femoral head articular easily breaks through a weak front-upper portion of the joint capsule and allows the front dislocation Boudreau. Articular head can then move further up, under the lumbar-iliac muscle (m. Iliopsoas) or inside. At the front hip dislocation vessels and nerves pass inwards from the joint head or under it and squeezed it can.
Anterior hip dislocation symptoms
When the front leg to straighten hip dislocation or very slightly bent, assigned, is turned outwards, and often not shortened due to leads, it seems even longer. Stress state does not allow the feet of active movements in it. Passive movements may slightly modified in the future direction of the provisions of the thigh. Under the crural arch femoral head or visible or easily detectable. Medially from it should pulse femoral artery, which can be squeezed. Nerves (n. Cruralis and n. Saphenus) may also be subjected to compression of the changes and provide sensitivity on the thigh and lower leg. If the trunk in the fall of elongated spaced legs are not tilted back, and vice versa, and the allotted vykruchennyh (rotate) outward leg maintains flexion position in the pelvis, then the violence head rests in the front-bottom of the bag.
As a result of fixing the field spits strongly stretched ligament (lig. Bertini) turns double-arm lever, whose short arm (femoral neck with the joint head) breaks the lower front part of the bag, it is at the foramen ovale and gives lower front hip dislocation. Symptoms are similar to the symptoms of his upper front hip dislocation, but are even more characteristic of the position expressed by foot - sharply bent at the hip and knee joints, and twisted allotted (internally rotated) outwards. In this position, the head is firmly fixed.
Greater importance is also quite rare displacement of the femoral head - through the broken bottom of the acetabulum (acetabuli), through which the perforation of the head and comes into the pelvic cavity. This dislocation-fracture occurs either by direct violence by trochanter (trochanter) or fall on its side. Movement of the hip, especially abduction dramatically difficult. The lateral size of the trochanter (trochanter) to the midline of the body is reduced in comparison with the healthy side. Push in the bottom of the pelvis with femoral head acetabuli well palpated through the rectum. On the X-ray of the pelvis shows a sharp projection bottom of the acetabulum (acetabuli) in the pelvic cavity, the transverse dimension of which is reduced.
Hip dislocations reduction
Hip dislocations reduction — quite a gratifying task. Even inveterate 1-2-month-old hip dislocation manage right. There have been cases when the reduction was possible even a year later. Hip dislocations reduction is best always performed under general anesthesia or spinal (epidural) anesthesia. Because the old methods reposition hip dislocation - stretching along the longitudinal axis of the left as irrational, due to a sharp voltage while iliofemorale ligament that prevents reduction.
When you reposition the rear hip dislocation of the new method is very popular method of Puteaux-Despres (Roiteau Despres), developed by Bigelow and based on hip flexion with rotation of its outward. The patient is placed on the floor. Assistant with both hands captures well the pelvis, and the surgeon is taken with both hands on the shin. Raising the leg up, he bends the knee and hip joint at a right angle and pull the thigh up. Bertinieva ligament while relaxing, and the head is installed at the rear edge of the pit. During the subsequent rotation outwards again strained his ligament Bertinieva will serve as a fulcrum, the guide head into the hole. If the reduction in this way is not possible, then in a continuous traction upward bent thigh, before you start retraction, you must make a more hip adduction and rotation inside to maneuver even more so relax Bertinievu bundle and bring the head as close to the glenoid fossa and then to fast rotation (rotation) outside and diverting push it into the joint hole.
Procedure of reposition hip dislocation with subsequent traction skeletal traction is performed under intravenous anesthesia.
In 1921 Dzhanelidze indicated method described in Malgaigne and applies even Collin and Colombot, - reposition hip dislocation in the prone position. Thigh while hanging down the side of the table. Bending the knee to a right angle and holding the hand of the ankle joint, the surgeon presses his knee in the popliteal fossa of the patient, producing, thus stretching the length of the thigh of the bent-axis rotates (rotates) in and take him. Anterior dislocation also reduce a lever according to the process, while relaxing Bertinievoy ligament hip flexion to a right angle; to increase the gap bags, made diversion; subsequent rotation of the thigh inside to bringing articular head takes the place.
After hip dislocation reposition requires:
- fixing bandage for 2-3 weeks
- drug therapy (NSAIDs, analgesics, hormones)
- therapeutic massage
- therapeutic exercises
- physical therapy (SMC, UHF, IT)
- acupuncture (with concomitant sciatic nerve traumatic neuropathy)