Hip iSAWE 13

Injury and assessment

• Posterior dislocation of the hip, dashboard mechanism
• Check sciatic nerve function, peroneal division most often affected
• Look for ipsilateral knee injury (patella, PCL) and femoral shaft fracture
• Look for acetabular posterior wall and femoral head fractures (Pipkin)

Urgent management

• Closed reduction under sedation or general anaesthesia within 6 hours
• Allis or Bigelow manoeuvre
• Do not attempt closed reduction with an undisplaced femoral neck fracture
• Post reduction CT for incarcerated fragments, non concentric reduction and fracture
• Open reduction if irreducible, through a posterior Kocher-Langenbeck approach
• Fix posterior wall fractures causing instability
• Document neurology before and after reduction

Complications

• Avascular necrosis, risk rises with delay over 6 hours
• Post-traumatic arthritis, the most common late complication
• Sciatic nerve palsy in about 10%
• Heterotopic ossification
• Recurrent dislocation is rare

Related pages

• Posterior Hip Dislocations