1. Dislocation of the hip joint
Three types of hip dislocation : -
1 . Anterior dislocation ( 10 – 15 %)
2 . Posterior dislocation ( 70 % )
3 . Central dislocation ( rest )

2. Hip joint

3. Posterior dislocation of hip
Common in the hip joint ( 70 % )
Mechanism of injury :
Dashbroad injury as in RTA
Simple dislocation : - Flexed knee + neutral adduction
Fracture dislocation : - flexed knee + slight abduction

4. Mechanism that causes the majority of dislocations is impingement (to strike )of the neck of the femoral component against the rim of the cup.

5. Pipkin Fracture
I - Posterior dislocation of the hip with fracture of the femoral head caudad to the fovea centralis
II - Posterior dislocation of the hip with fracture of the femoral head cephalad to the fovea centralis
III - Type I and type II with associated fracture of the femoral neck
IV - Type I, II, or III with associated fracture of the acetabulum

7. Femur bone showing fovea centralis

8. Clinical features Limb shortening
Flexion , adduction and medial rotation deformity of the affected limb
Thigh rest on the contralateral limb
Head felt in the gluteal region
Movement of hip decrease
Feature of sciatic nerve palsy

9. Feature of sciatic nerve palsy
SCIATICA or pain localized to the hip,
PARESIS or PARALYSIS of posterior thigh muscles and muscles innervated by the peroneal and tibial nerves,
sensory loss involving the lateral and posterior thigh, posterior and lateral leg, and sole of the foot.
Pain when sitting, sneezing or coughing
tingling sensation or numbness down the leg
Foot drop

10. Fig:- Foot drop

11. Radiology
X – ray AP and Lateral view of the pelvis showing both the hip joints
CT scan and MRI ( for acetabular fracture)

12. Treatment Closed reduction ( to reduce pain ) : -
Four methods of closed reduction : -
1 . Stimson`s method : -
Position : prone , at the edge of the table
An assistant stabilizes the pelvis
Physician applies downward pressure on the calf with one hand while applying external rotation to the femur.

13. 2 .Allis traction 3 . Bigelow`s method: -
Position : supine
An assistant stabilizes the pelvis
The physician simultaneously distract (to pull away ) the femur and rocks it medial to lateral .
3 . Bigelow`s method: -
Physician applied upwards traction on the femur while an assistant stabilize the pelvis
4 .Classical watson`s – jones method : -
Limb is brought to the neutral position first then longitudinal traction in the of femur is given.

14. After treatment
After reduction , the patient is put on a skin traction or immobilised in a Thomas split for 3 weeks .
Full weight bearing after 6 weeks .
Indication of open reduction : -
1 . Failure of close reduction : due to obstruction by bony fragments or by soft tissues .
2 . Instability after reduction
3 . Sciatic nerve palsy

15. Complications Early : - Late : - Sciatic nerve palsy
Irreducible fracture dislocation
Missed knee injuries
Recurrent dislocation
Late : -
Myositis ossificans
Avascular necrosis of bone
Post – traumatic arthritis
Unreduced posterior dislocation