Hip Injuries and Dislocations Overview
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Questions and Answers

Hip dislocation is a rare injury, but it often has associated injuries.

True

What type of trauma is generally associated with hip dislocation?

  • Low Energy
  • High Energy (correct)

    • A simple hip dislocation is when there is a fracture in the hip joint.

    False

    The majority of hip dislocations involve the posterior side of the hip.

    <p>True</p> Signup and view all the answers

    What type of injury is NOT commonly associated with hip dislocations?

    <p>Spinal cord injury</p> Signup and view all the answers

    What is the commonly observed position of the hip and leg in patients with a posterior hip dislocation?

    <p>Slight flexion, adduction, and internal rotation</p> Signup and view all the answers

    What is the diagnostic imaging modality of choice for initial assessment of hip dislocation?

    <p>X-ray</p> Signup and view all the answers

    A CT scan is often used to determine the direction of dislocation, identify loose bodies, and detect associated fractures.

    <p>True</p> Signup and view all the answers

    Which medical procedure is often considered for the treatment of a hip dislocation?

    <p>Closed reduction</p> Signup and view all the answers

    What percentage of hip dislocations are accompanied by associated injuries?

    <p>95%</p> Signup and view all the answers

    In cases of a simple hip dislocation, protected weight bearing is typically advised for 4-6 weeks after reduction.

    <p>True</p> Signup and view all the answers

    Which of the following is NOT an indication for operative treatment of a hip dislocation?

    <p>Simple dislocation</p> Signup and view all the answers

    In hip dislocations where a femoral neck fracture is present, the neck fracture should be stabilized before reducing the hip.

    <p>True</p> Signup and view all the answers

    What is the common name for the injury that occurs when a driver's knee hits the dashboard during an accident?

    <p>Dashboard Injury</p> Signup and view all the answers

    Femoral neck fractures are more common in younger populations.

    <p>False</p> Signup and view all the answers

    Which of the following demographic groups is more susceptible to femoral neck fractures?

    <p>Women</p> Signup and view all the answers

    Femoral neck fractures are generally caused by high-energy trauma in older patients.

    <p>False</p> Signup and view all the answers

    Femoral neck fractures often involve associated injuries like femoral shaft fractures.

    <p>True</p> Signup and view all the answers

    What is the most significant factor determining survival after a femoral neck fracture?

    <p>Pre-injury mobility</p> Signup and view all the answers

    The femoral neck is located outside the joint capsule, which makes it more susceptible to fracture.

    <p>False</p> Signup and view all the answers

    The lack of a periosteal layer around the femoral neck makes it difficult for the bone to form callus and heal.

    <p>True</p> Signup and view all the answers

    What is the primary artery that contributes to the blood supply of the femoral head?

    <p>Medial femoral circumflex artery</p> Signup and view all the answers

    The displacement of a femoral neck fracture does not affect the blood supply to the femoral head.

    <p>False</p> Signup and view all the answers

    Which classification system is used to categorize femoral neck fracture based on the degree of fracture displacement?

    <p>Garden classification</p> Signup and view all the answers

    The Pauwels classification focuses on the angle between the fracture line and the shaft of the femur.

    <p>True</p> Signup and view all the answers

    The anatomical classification of femoral neck fractures considers the location of the fracture in the neck.

    <p>True</p> Signup and view all the answers

    What is the characteristic symptom associated with an impacted or stress fracture of the femoral neck?

    <p>Slight pain in the groin or referred pain down the thigh</p> Signup and view all the answers

    A displaced fracture of the femoral neck usually causes pain only in the entire hip region.

    <p>True</p> Signup and view all the answers

    Patients with impacted femur neck fractures typically have a significant outward rotation of the leg.

    <p>False</p> Signup and view all the answers

    Which type of x-ray image, taken in a specific position, is considered ideal for defining the fracture type of a femoral neck fracture?

    <p>Traction-internal rotation AP (anteroposterior)</p> Signup and view all the answers

    The Garden classification system is mainly based on the AP (anteroposterior) projection of the pelvis.

    <p>True</p> Signup and view all the answers

    Non-operative treatment for femoral neck fractures using bed rest is only recommended for patients who are unable to walk.

    <p>False</p> Signup and view all the answers

    Which surgical procedure is usually considered for a displaced femoral neck fracture in a young patient?

    <p>CRIF (cannulated screw fixation)</p> Signup and view all the answers

    Dynamic hip screw, a surgical procedure, is generally considered superior to multiple cancellous screws in terms of biomechanics.

    <p>True</p> Signup and view all the answers

    Hemiarthroplasty is typically preferred for patients with a low risk of developing post-traumatic arthritis.

    <p>False</p> Signup and view all the answers

    Which of the following is NOT a common complication associated with femoral neck fractures?

    <p>Deep vein thrombosis</p> Signup and view all the answers

    The decision to treat a femoral neck fracture operatively or non-operatively is influenced by the patient’s age and the extent of fracture displacement.

    <p>True</p> Signup and view all the answers

    Fixing a femoral neck fracture takes priority over fixing an ipsilateral femoral shaft fracture.

    <p>True</p> Signup and view all the answers

    In the treatment of femoral neck fractures, achieving an anatomical reduction is necessary to avoid complications like osteonecrosis.

    <p>True</p> Signup and view all the answers

    Which fracture type is often treated with multiple cancellous screws?

    <p>Transcervical fracture</p> Signup and view all the answers

    The use of a dynamic hip screw is generally preferred over multiple cancellous screws for vertical fractures in a young patient.

    <p>True</p> Signup and view all the answers

    The primary goal of a dynamic hip screw is to achieve a controlled collapse of the fracture fragment.

    <p>True</p> Signup and view all the answers

    Hemiarthroplasty is a surgical procedure involving the replacement of both the femoral head and the acetabulum.

    <p>False</p> Signup and view all the answers

    Hemiarthroplasty is considered a suitable treatment option for patients with metabolic bone disease such as osteoporosis.

    <p>True</p> Signup and view all the answers

    What is the primary factor influencing the decision to choose non-operative treatment for a femoral neck fracture?

    <p>Patient's overall health status</p> Signup and view all the answers

    Study Notes

    Hip Injuries

    • Hip dislocation is rare but often involves associated injuries.
    • The mechanism is typically high-energy trauma in young patients.
    • Hip dislocation is a significant orthopaedic emergency.

    Hip Dislocation Classification

    • Simple: Pure dislocation without additional fractures.
    • Complex: Dislocation with fracture of the acetabulum or proximal femur.

    Anatomical Classification (Posterior Dislocation)

    • Posterior dislocation accounts for about 90% of cases.
    • It occurs with axial loading on the femur, usually when the hip is flexed and adducted.
    • Dashboard injuries are a common cause due to axial loading through a flexed knee.

    Associated Injuries with Posterior Dislocation

    • Avascular necrosis (osteonecrosis) of the femoral head can occur.
    • Posterior wall acetabular fractures may be present.
    • Femoral head fractures can occur.
    • Sciatic nerve injuries can result in the impairment of the nerve.
    • Ipsilateral knee injuries can be observed in approximately 25% of cases.

    Anatomical Classification (Anterior Dislocation)

    • Anterior dislocation is associated with femoral head impaction or chondral injury.
    • This occurs when the hip is in abduction and external rotation.

    Clinical Presentation of Hip Injuries

    • History: Includes symptoms and circumstances leading up to the injury.
    • Symptoms: Acute pain, inability to bear weight, deformity (obvious malformation).
    • Physical Exam: ATLS (Advanced Trauma Life Support) protocol is important, as 95% of dislocations occur with associated injuries.

    Clinical Presentation (Posterior Dislocation)

    • Commonly associated with posterior wall and anterior femoral head fractures.
    • The hip and leg exhibit slight flexion, adduction and internal rotation.
    • Neurovascular exam is crucial (sciatic nerve injury possibly occurs in 10-20% of cases)
    • Examine the knee for any associated injuries as well.

    Clinical Presentation (Anterior Dislocation)

    • The hip and leg exhibit flexion, abduction and external rotation.
    • Often an obvious malformation can be observed.

    Radiology of Hip Injuries

    • X-ray: AP pelvis view often reveals posterior dislocation. The femoral head is usually smaller on the injured side compared to the uninjured. Shenton's line, a curved line, is often broken. The lesser trochanter shadow may not be apparent in the affected (internally rotated) limb.
    • CT: Used to determine the direction of dislocation to exclude any loose bodies and associated fractures in the area.

    Treatment of Hip Injuries

    • Hip injuries are orthopaedic emergencies.
    • Immediate ATLS protocol is paramount.
    • Perform emergent closed reduction (UGA) within 6 hrs.
    • The patient is supine and traction is applied in line with the deformity.
    • Adequate sedation and muscle relaxation are essential.
    • Evaluate hip stability after reduction.

    Post-reduction of Hip Injuries

    • Post-reduction CT scan is often required to detect associated fractures and verify correct concentricity of reduction (incarcerated fragments are addressed).
    • Protected weight bearing is typically required for 4 to 6 weeks after a simple dislocation.

    Operative Treatment of Hip Injuries (Open Reduction)

    • Necessary for irreducible dislocations, incarcerated fragments, delayed presentations, or non-concentric reduction.
    • Open reduction and/or removal of the incarcerated fragments are often done on an urgent basis.
    • Associated fractures of the acetabulum, femoral head, or femoral neck may need to be stabilized prior to reducing the hip.

    Complications of Hip Injuries

    • Post-traumatic osteoarthritis (OA): Can occur in up to 20% of simple dislocations and is more frequent in complex cases.
    • Femoral head osteonecrosis: Occurs in 5-40%, often linked with a delayed reduction.
    • Sciatic nerve injury: Has an incidence of 8-20% and can delay treatment.
    • Associated fractures: fractures to the femur shaft.

    Femoral Neck Fracture

    • Epidemiology: Common in the aging population (women more than men, postmenopausal often).
    • Mechanism of Trauma: Usually high-energy in youth and low-energy falls in older adults.
    • Associated injuries: Femoral shaft fractures (6-9%)
    • Prognosis: Higher mortality rates (25-30% at 1 year) compared to vertebral compression fracture, often pre-injury mobility is a key determinant of post-operative outcome.

    Pathophysiology of Femoral Neck Fractures

    • The femoral neck is bathed in synovial fluid (intracapsular), lacks a periosteal layer, leading to limited callus formation, and negatively impacting healing.

    Blood Supply to the Femoral Head

    • The medial femoral circumflex artery is a major supplier; contributions also come from the lateral femoral circumflex artery and the artery of the ligamentum teres. Proper blood supply to femoral neck is critical since a disrupted blood supply (often seen in displaced femoral neck fractures) may cause intracapsular hematoma.

    Classification of Femoral Neck Fractures (Garden Classification)

    • Garden stage I: Undisplaced and incomplete, often valgus impacted, in which no actual bone dislocation exists.
    • Garden stage II: Undisplaced complete fracture
    • Garden stage III: Complete fracture, incompletely displaced
    • Garden stage IV: Completely displaced, complete fracture

    Classification of Femoral Neck Fractures (Pauwels Classification)

    • This classification is based on the inclination angle of the fracture line to the femoral neck and varies based on I/II/III levels.

    Anatomical Classification of Femoral Neck Fractures

    • Transcervical fracture
    • Basicervical frcture
    • Subcapital fracture

    Clinical Presentation, Symptoms

    • Impacted & stress fractures: Mild to moderate groin pain, pain along the medial aspect of thigh/knee.
    • Displaced fractures: Pain in the entire hip region.

    Clinical Presentation, Physical Exam

    • Impacted & stress fractures: Mild discomfort with ROM (active or passive), no obvious deformity, muscle spasms at extremes of motion, localised pain when percussion is applied over the greater trochanter.
    • Displaced fractures: Obvious Clinical deformity (patient cannot walk), pain with percussion, leg in external rotation and abduction, leg shortening.

    Radiology

    • Obtain AP pelvis and cross-table lateral images of the femur. Internal rotation. AP hip images are often used to precisely define the fracture type. Garden classification is primarily based on AP pelvis x-rays.

    Treatment, Nonoperative

    • Bed rest.
    • Considered for some non-ambulatory patients with minimal pain and high risk to sustain surgical intervention.

    Treatment, Operative (CRIF)

    • Indicated for displaced fractures in younger/physiologically younger patients (< 65 years old).

    Treatment approach (General Considerations)

    • Based on: Displacement, patient's physiological age, presence of ipsilateral femoral neck and shaft fractures. Femoral neck fracture is most crucial and usually addressed first to avoid AVN & non-union complications.

    Treatment (Multiple Cancellous Screws)

    • Indications applicable to nondisplaced and minimally displaced transcervical and Garden classification I/II fractures in older patients with nondisplaced or minimally displaced fractures. Displaced transcervical fractures in younger patients. Surgical intervention may be essential. Necessary steps include reducing any displaced fractures to minimise vascular compromise.

    Treatment (Dynamic (Sliding) Hip Screw)

    • Indications include basicervical fractures and vertical fractures in younger patients. This approach is often biomechanically better than multiple cancellous screws.

    Treatment (Hemiarthroplasty)

    • Debilitated elderly patients
    • Metabolic bone disease (osteoporosis)
    • Neglected fractures

    General Considerations for Surgical Procedure

    • Reduction method and quality has more pronounced effect on healing than time of surgery. Bring elderly patients to surgery as soon as medically feasible. Emphasise the benefits of early post-surgery mobility. Good clinical outcomes are improved in younger/medcially fit patients if surgery is performed within 4 days from the injury.

    Complications from Hip Fracture Treatment

    • Avascular necrosis (AVN) of femoral head
    • Non-union
    • Mal-union
    • Associated fractures (femoral shaft)
    • Post-traumatic Osteoarthritis (OA)

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    Description

    This quiz covers the critical aspects of hip injuries, particularly focusing on dislocations. It explores the classification of hip dislocations, mechanisms of injury, and associated complications. Understand the significance of quick diagnosis and treatment to prevent further injuries.

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