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Orthobullets Trauma > Hip Dislocation > Flashcards

Hip Dislocation Flashcards

1
Q

soft tissue constraints on the hip joint

A

labrum
capsule
ligamentum teres

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2
Q

pure dislocation without associated fracture

A

simple dislocation

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3
Q

what is a simple dislocation?

A

pure dislocation without associated fracture

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4
Q

dislocation associated with fracture of acetabulum or proximal femur

A

complex dislocation

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5
Q

what is a complex dislocation

A

dislocation associated with fracture of acetabulum or proximal femur

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6
Q

most common direction of dislocation

A

posterior

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7
Q

occur with axial load on femur, typically with hip flexed and adducted

A

posterior dislocation

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8
Q

posterior dislocation biomechanics

A

occur with axial load on femur, typically with hip flexed and adducted

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9
Q

axial load through flexed knee (dashboard injury)

A

posterior dislocation

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10
Q

increasing flexion and adduction favors ____ dislocation

A

simple

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11
Q

increasing flexion and _____ favors simple dislocation

A

adduction

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12
Q

posterior dislocation associations

A

osteonecrosis
posterior wall acetabular fracture
femoral head fractures
sciatic nerve injuries
ipsilateral knee injuries (up to 25%)

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13
Q

associated with femoral head impaction or chondral injury

A

anterior dislocation

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14
Q

anterior dislocation associated with femoral head impaction or ____

A

chondral injury

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15
Q

anterior dislocation associated with ____ or chondral injury

A

femoral head impaction

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16
Q

occurs with the hip in abduction and external rotation

A

anterior dislocation

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17
Q

anterior dislocation occurs with the hip in _____ and external rotation

A

abduction

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18
Q

anterior dislocation occurs with the hip in abduction and ____

A

external rotation

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19
Q

anterior dislocation can be further classified as

A

superior or inferior

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20
Q

hip extension results in a _____ (pubic) dislocation

A

superior

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21
Q

hip _____ results in a superior (pubic) dislocation

A

extension

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22
Q

Clinically hip appears in extension and external rotation

A

superior/anterior dislocation

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23
Q

flexion results in _____ (obturator) dislocation

A

inferior

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24
Q

_____ results in inferior (obturator) dislocation

A

flexion

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25
Q

Clinically hip appears in flexion, abduction, and external rotation

A

inferior/anterior

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26
Q

symptoms

A

acute pain, inability to bear weight, deformity

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27
Q

____% of dislocations with associated injuries

A

95

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28
Q

associated with posterior wall and anterior femoral head fracture

A

posterior dislocation

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29
Q

hip and leg in slight flexion, adduction, and internal rotation

A

posterior dislocation

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30
Q

posterior dislocation associated with ____ fracture

A

posterior wall and anterior femoral head

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31
Q

percentage of posterior dislocations with sciatic nerve injury

A

10-20%

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32
Q

examine ____ for associated injury or instability

A

knee

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33
Q

chest X-ray ATLS workup for ____

A

aortic injury

34
Q

hip and leg in extension, abduction, and external rotation

A

anterior dislocation

35
Q

radiographic views prior to reduction

A

AP and cross table lateral

36
Q

used to differentiate between anterior vs. posterior dislocation

A

cross table lateral

37
Q

cross table lateral usage

A

used to differentiate between anterior vs. posterior dislocation

38
Q

scrutinize ____ to rule out fracture prior to attempting closed reduction

A

femoral neck

39
Q

views to obtain after reduction

A

AP, inlet/outlet, judet views

40
Q

general radiographic findings:

A

loss of congruence
disruption of shenton’s line

41
Q

arc along inferior femoral neck + superior obturator foramen

A

shenton’s line

42
Q

what is shenton’s line

A

arc along inferior femoral neck + superior obturator foramen

43
Q

femoral head appears larger than contralateral femoral head
femoral head is medial or inferior to acetabulum

A

anterior dislocation

44
Q

radiographic findings of anterior dislocation

A

femoral head appears larger than contralateral femoral head
femoral head is medial or inferior to acetabulum

45
Q

femoral head appears smaller than contralateral femoral head
femoral head superimposes roof of acetabulum
decreased visualization of lesser trochanter due to internal rotation of femur

A

posterior dislocation

46
Q

posterior dislocation radiographic findings

A

femoral head appears smaller than contralateral femoral head
femoral head superimposes roof of acetabulum
decreased visualization of lesser trochanter due to internal rotation of femur

47
Q

femoral head appears larger than contralateral femoral head

A

anterior dislocation

48
Q

femoral head is medial or inferior to acetabulum

A

anterior dislocation

49
Q

femoral head appears smaller than contralateral femoral head

A

posterior dislocation

50
Q

femoral head superimposes roof of acetabulum

A

posterior dislocation

51
Q

decreased visualization of lesser trochanter due to internal rotation of femur

A

posterior dislocation

52
Q

helps to determine direction of dislocation, loose bodies, and associated fractures

A

CT

53
Q

CT usage

A

helps to determine direction of dislocation, loose bodies, and associated fractures

54
Q

post reduction ____ must be performed for all traumatic hip dislocations

A

CT

55
Q

post reduction CT must be performed for all _____

A

traumatic hip dislocations

56
Q

post reduction CT must be performed for all traumatic hip dislocations to look for

A

femoral head fractures
loose bodies
acetabular fractures

57
Q

useful to evaluate labrum, cartilage and femoral head vascularity

A

MRI

58
Q

MRI usage

A

useful to evaluate labrum, cartilage and femoral head vascularity

59
Q

non op management

A

emergent closed reduction within 12 hours

60
Q

non op indications

A

acute anterior and posterior dislocations

61
Q

non op contraindications

A

ipsilateral displaced or non-displaced femoral neck fracture

62
Q

operative techniques

A

open reduction and/or removal of incarcerated fragments
ORIF
arthroscopy

63
Q

open reduction and removal of incarcerated fragments indications

A

irreducible dislocation
radiographic evidence of incarcerated fragment
delayed presentation
non-concentric reduction
should be performed on urgent basis

64
Q

irreducible dislocation
radiographic evidence of incarcerated fragment
delayed presentation
non-concentric reduction
should be performed on urgent basis

A

indications for open reduction and removal of incarcerated fragments

65
Q

ORIF indications

A

associated fractures of
acetabulum
femoral head
femoral neck

66
Q

arthroscopy indications

A

no current established indications
potential for removal of intra-articular fragments
evaluate intra-articular injuries to cartilage, capsule, and labrum

67
Q

no current established indications
potential for removal of intra-articular fragments
evaluate intra-articular injuries to cartilage, capsule, and labrum

A

arthroscopy

68
Q

closed reduction-perform with patient supine and apply traction in line with _____ regardless of direction of dislocation

A

deformity

69
Q

must have adequate sedation and muscular relaxation to perform ____

A

reduction

70
Q

assess hip ____ after reduction

A

stability

71
Q

post reduction-for simple dislocation, follow with protected weight bearing for _____ weeks

A

4-6

72
Q

ORIF approach to posterior dislocation

A

posterior (Kocher-Langenbeck) approach

73
Q

ORIF approach to anterior dislocation

A

anterior (Smith-Petersen) approach

74
Q

may place patient in traction to reduce forces on cartilage due to ____ or in setting of unstable dislocation

A

incarcerated fragment

75
Q

may place patient in traction to reduce forces on cartilage due to incarcerated fragment or in setting of _____

A

unstable dislocation

76
Q

complications:

A

post traumatic arthritis
femoral head osteonecrosis
sciatic nerve injury
recurrent dislocations

77
Q

post traumatic arthritis incidence

A

up to 20% for simple dislocation, markedly increased for complex dislocation

78
Q

incidence of femoral head osteonecrosis

A

5-40%

79
Q

femoral head osteonecrosis risk increased with ____

A

increased time to reduction

80
Q

sciatic nerve injury incidence

A

8-20%

Orthobullets Trauma (63 decks)

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