MUSCULOSKELETAL TRAUMA

Dr. Nur Rachmat Lubis, SpOT

FRACTURE & DISLOCATION
FRACTURE
Definition :
A fracture, whether of a bone, an epiphyseal plate or
a cartilaginous joint surface, is simply a structural
break in its continuity.

must be consider :
surrounding soft tissue around the fracture site
Physical factors in the Production of Fractures
1. Cortical Bone:
can withstand compression and shearing forces better that
it can withstand tension forces
2. Cancellous Bone/ spongious:
Cant withstand compression.
Can produced:
Crush # / compression #
Impacted #
Descriptive Terms Pertaining to
Fractures
1. Fracture site :
Diaphyseal
Metaphyseal
Epiphyseal
2. Extent of Fracture:
complete
Incomplete
3. Configuration of #:
1. Transverse
2. Oblique
3. Spiral
4. Comminuted
1
2 3
4
4. Relationship of the Fracture
Fragments to Each Other :
Undisplaced
Displaced :
1. Overriding
2. Angulated
3. Rotated
4. Distracted
5. Impacted
6. Shifted
sideways

Relationship of the fracture fragments to each other
caused by :
Effects of Gravity
Effects of muscle pull on the fragments
5. Relationship of the Fracture to the External
Environment:
Closed #
Open #:
Fracture fragment has penetrated the skin ( from within)
Sharp object has penetrated the skin to # the bone (from
without)
6. Complication :
Uncomplicated
Complicated:
Local : Infection
Systemic : Emboli, Sepsis

THE DIAGNOSIS OF FRACTURES
HISTORY :
Fall, Direct Trauma.
Mechanism of injury.
Common symptom of # :
Localized pain.
Decreased function of the involved
part.
THE DIAGNOSIS OF FRACTURES
PHYSICAL EXAMINATION:
INSPECTION ( LOOKING ):
Swelling ( edema )
Deformity( angulations, rotation, shortening )
Abnormal movement
Echymosis( subcutaneous extravasations of blood )
PALPATION ( FEELING ) :
Localized tenderness at the # site.
Crepitus (not necessary)
RANGE OF MOVEMENT (ROM):
Limitation.
THE DIAGNOSIS OF FRACTURES
!!!! CAREFULL ASSESSMENT
Patients General Condition
Search for associated injuries:
Brain
Spinal Cord
Peripheral Nerves
Major vessels
Thoraces
Abdominal viscera
THE DIAGNOSIS OF FRACTURES
RADIOGRAPHIC EXAMINATION:
# : PHYSICAL EXAMINATION
Confirmation by X-Ray Accurate Diagnosis
To determine extent and configuration of the fracture.
Include entire length of the bone and the joints at each
end.
2 Projection : AP / Lat, particularly oblique
Spine and pelvis : (+) CT
THE NORMAL HEALING OF FRACTURES
1. Cortical bone (diaphyseal bone/ tubular bone)
# torn of blood vessels, canaliculi, Haversian canal on the
# site Osteocyte in the lacunae

A vascular
Bleeding from periosteum
1. Fracture Hematoma

Localized on the end of fragment #
Osteogenic cells from periosteum formed
External callus
From endosteum Internal callus
Cartilage callus change in to bone by
Endochondral Ossification
2 Clinical Union ( fracture line still apparent)
3 Consolidation ( Radiographic Union )
4 Remodeling
THE NORMAL HEALING OF FRACTURES
2. CANCELLOUS BONE
Internal Fracture Hematoma
osteogenic cells from trabeculae

Internal callus

Clinical Union

Consolidation
THE TIME REQUIRED FOR UNCOMPLICATED # HEALING
FACTOR INFLUENCE:
1. Age of the patient
Younger age, the healing rate faster.
Example :
femur # after birth union 3 weeks
femur # on the age 8 year union 8 weeks
femur # on the age 12 year union 12 weeks
femur # on the age 20 th/> union 20 weeks
HEALING TIME UNCOMPLICATED #
2. # Site and Configuration
# through bones that are surrounded by muscle
>union faster
cancellous bone # > union faster than
cortical bone
long oblique / spiral # > union faster than
transverse #
WAKTU PENYEMBUHAN # UNCOMPLICATED
3. Initial Displacement of the Fracture :
undisplaced #, intact periosteum heal
twice as rapidly as displaced #

4. Blood supply to the Fragments :
If both fracture fragments have a good blood
supply healing faster
ABNORMAL HEALING OF FRACTURES
MALUNION
Heal normally expected time but in unsatisfactory
position with residual bone deformity
DELAYED UNION
union time longer than normal
NON UNION
fractures fail to heal by bone :
Fibrous Union
False joint (Pseudoarthrosis)
PRELIMINARY CARE FOR PATIENTS WITH #
PRIORITY
1. Airway
2. Breathing
3. Shock
4. # and dislocation
Complete PE
Splinting Extr # :
To minimize pain
Prevent further injury to the soft tissue
INITIAL
SPESIFIC METHODS OF TREATMENT FOR CLOSED FRACTURES
1. Protection alone(without reduction/immobilization)
Indication : # costa stable,
# undisplaced
# stable
2. Immobilization by external splinting (without
reduction)
3. Closed Reduction by manipulation followed by
immobilization
4 Closed reduction bt continuous traction followed by
immobilization

SPESIFIC METHODS OF TREATMENT FOR
CLOSED FRACTURES
5. Closed Reduction followed by Functional
Fracture Bracing
6. Closed Reduction by manipulation followed by
External Skeletal Fixation
7. Closed Reduction by manipulation followed by
Internal Skeletal Fixation
8. Open Reduction followed by Internal Skeletal
Fixation
9. Excision of a # fragment and replacement by an
Endoprosthesis
CLASSIFICATION OF OPEN #
TYPE I
Wound < 1 cm
Clean wound
Bone penetrated skin with minimal injury to
the muscle (usually from within)
Simple #, transverse, short oblique

CLASSIFICATION OF OPEN #
TYPE II:
Wound > 1 cm
Without extensive soft tissue damage, skin
flaps or avulsion
simple # transverse, short oblique,mild
comminuted

CLASSIFICATION OF OPEN #
TYPE III:
Extensive soft tissue damage ; skin, muscle,
nerve injuries and major arterial injury
Often caused by high speed injury
Example :
Traffic accident, farm accidents
Gunshot wound
> 8 hours
CLASSIFICATION OF OPEN #
TYPE III A :
High speed injury, soft tissue can coverage the wound
Segmental # or severe cominutted
TYPE III B :
High speed injury
> soft tissue loss
Avulsion of periosteum
Wound with severe contamination
TYPE III C :
Major arterial injury need to repair
SPECIAL TYPES OF #
Stress # (fatigue #) :
March # metatarsal II-III #
Prox. Tibia # jumpers and ballet dancers
Pathological # :
Occur in abnormal bone
Without major trauma
DISLOCATION
Structural loss of its stability
3 structure that prevent normal ROM & also
prevent joint stability

Joint shape ( joint surface )

Capsule and ligament

Muscle that prevent joint stability
DISLOCATION
3 DEGREES OF JOINT INSTABILITY :
1
st
Degree : Occult Joint instability
( apparent only when joint is stressed)
2
nd
Degree : Subluxation
( less than luxation)
3
rd
Degree : Dislocation (Luxation)
( joint surfaces have completely lost
contact)

DISLOCATION
Joint most susceptible to traumatic dislocation:
Shoulder
Elbow
Hip
Inter phalangeal
Ankle

DIAGNOSIS
Physical Examination :
Swelling (edema)
Deformity ( angulation, rotation, loss of normal
contour, shortening)
Abnormal movement
Local tenderness
Radiographic Examination :
Typical features of a subluxation
AP / LAT projection
SPECIFIC TYPES OF JOINT INJURIES
CONTUSION:
Hemarthrosis (rupture of synovial vessels)
Normal X-ray
LIGAMENTOUS SPRAIN:
Acute sprain, strain sudden stretching of the ligament
withincomplete tears local hemorrhage local
swelling tenderness, pain aggravated by movement
Radiographic examination : normal
Treatment : strapping / splinting
DISLOCATION :
Anatomical reduction
immobilization

SPECIFIC FRACTURES AND JOINT INJURIES IN
ADULTS
Fracture less common, but more serious
Weaker and less active Periosteum
Less rapid fracture healing
Fewer problems of Diagnosis
No spontaneous correction of residual fracture
deformities
Differences in complication:
Open fracture > common in adult
Major arterial trauma
Fat embolism

SPECIFIC FRACTURES AND JOINT INJURIES IN
ADULTS
Torn ligaments and Dislocations more common
Because > rigid, child > elastic
If in children make separation in adult dislocation / #
dislocation
Better tolerance of major blood loss
Different emphasis on methods of treatment
> frequently require ORIF
If undisplaced # , adult tend to be more cooperative during
treatment, # can be treated by protection alone


SPECIFIC FRACTURES AND DISLOCATIONS
THE HAND
General features:
Common
Treatment should always deference prevent
disability
Edema >> disturbance function elevation
to
# digits immobilized as short as possible never
more than 3 weeks
finger Immobilized in the flexed position

SPECIFIC FRACTURES AND DISLOCATIONS
THE HAND
1. DISTAL PHALANX :
Mallet Finger ( baseball finger, cricket finger )
Caused by:
Passive flexion distal of the interphalangeal joint with the
extensor tendon under tension may avulse a fragment of
bone from the base of the distal phalanx into which the
tendon is inserted.
Treatment:
Acute : Splinting the finger with DIP joint extended & the
PIP joint flexed 3 weeks.
ORIF with wire fixation.
SPECIFIC FRACTURES AND DISLOCATIONS
THE HAND
2. MIDDLE & PROXIMAL PHALANGES
# as result of crushing / hyperextension injury
Undisplaced # :
Treatment: strapping to adjacent finger,
Allow movement of the fingers joint(+)
Usually stable
displaced # :
Frequently anterior angulation
Treatment : ORIF if unstable
3. DISLOCATION OF THE MP. JOINTS
Severe hyperextention injury
Treatment : closed reduction

SPESIFIC FRACTURES AND DISLOCATIONS
THE HAND
4. METACARPAL S:
1.Boxer Fracture ( Street
Fighter # ):
# neck metacarpal V
Street fighters #
Treatment :
Reduction
Immobilized in cast not more
than 2 weeks
ORIF with K-wire fixation if #
unstable
SPESIFIC FRACTURES AND DISLOCATIONS
THE HAND

2. Bennets Fracture :
# dislocation of the 1
st
carpo
metacarpal joint
Longitudinal force along the axis of
the 1
st
metacarpal with the
thumb in flexed
Serious intraarticular fracture
dislocation of the CMC joint
Treatment:
Closed reduction
ORIF K-wire

SPESIFIC FRACTURES AND DISLOCATIONS
THE HAND
3. Rolando # :
# base 1
st
metacarpal with
intrarticular T or Y #


SPESIFIC FRACTURES AND DISLOCATIONS
THE HAND
5. # SCAPHOID
Relative common in young adults, particularly in males
Fall on the open hand with the wrist dorsiflexed and radially
deviated
Clinical features:
Pain on the radial side of the wrist, particularly on
dorsoflexion and radial deviation
Radigraphical features:
Not clearly outlined in AP projection, requires special oblique
projections ( scaphoid view)

SPESIFIC FRACTURES AND DISLOCATIONS
THE HAND
Treatment :
Undisplaced immobilized in scaphoid cast
Complication :
Avascular necrosis
Delayed union
Non union
Post traumatic degenerative joint disease
SPESIFIC FRACTURES AND DISLOCATIONS
THE WRIST AND FOREARM
1. Distal end of the Radius ( Colles # )
Colles # :
# radius, 2,5 cm / 1 inch from wrist joint
Commonest # in adults, > 50 th
>
Fracture occur through bone that has became markedly
weakened by combination senile & post menopausal
osteoporosis
Mechanism of injury :
fall with lands on outstretched hand position
Clinical features:
Dinner fork deformity : posterior displacement or posterior tilt of the
distal radial fragment
COLLES FRACTURE
CLINICAL FEATURES : DINNERS FORK DEFORMITY
COLLES FRACTURE
Radiographic features :
Stable type :
There is 1 main transverse # line with little cortical
comminution
Unstable type :
Gross comminution, particularly of the dorsal cortex,
and also marked crushing of the cancellous bone
COLLES FRACTURE
TREATMENT :
Undisplaced # : immobilization with Below Elbow
Cast for 4 weeks
Displaced # : Closed Reduction + BE cast
Closed Reduction+ External Fixation
COMPLICATION :
Usually Colles # had clinical union in acceptable position within
6 weeks
Preventable complication:
Finger Stiffness, Shoulder stiffness, malunion
Rare complication: Sudecks Reflex Symphatetic Dystrophy
Late rupture EPL
SPESIFIC FRACTURES AND DISLOCATIONS
THE WRIST AND FOREARM
2. Reverse Colles # /
Smiths #
Predominantly in young men
Occurs young adults
Fall on the back of the flexed
wrist and hence is a pronation
injury
Distal fragment dislocated to the
anterior side

SMITHS #
Treatment :
Closed reduction requires strong supination of
the wrist
Above Elbow Cast, for 6 weeks, maintain the
position in supination


SPESIFIC FRACTURES AND DISLOCATIONS
THE WRIST AND FOREARM
3.Bartons #
Other form of smith #
Intra articular #
FRACTURE OF THE SHAFT OF THE
RADIUS AND ULNA
RADIUS ULNA :

1. GALEAZZI # :
# of the shaft of the radius and dislocation
of the distal radio-ulnar joint.
displaced # of distal third of the radial shaft
associated with complete disruption &
dislokation of the distal radioulnar joint.
Usually sustained by young adults
Distal fragment tilted posteriorly


FRACTURE OF THE SHAFT OF THE
RADIUS AND ULNA
Treatment :
Open Reduction & Internal
fixation of the radius, the
dislocatiwill be on reduced.
FRACTURE OF THE SHAFT OF THE
RADIUS AND ULNA
2. PROXIMAL RADIUS # :
Tend to rotate
Treatment : ORIF
Complication:
Delayed union
Non union
FRACTURE OF THE SHAFT OF THE
RADIUS AND ULNA
3. RADIUS ULNA # :
> difficult to treat
Treatment : ORIF for both bone
Complication :
Delayed union
Non union
Cross union (must avoided)
FRACTURE OF THE SHAFT OF THE
RADIUS AND ULNA
4. MONTEGGIA # :

# of the Prox half of the ulna accompanied by
anterior dislocation of the prox radioulnar joint
Dislocation post / ant
Common type, hyperextension & pronation injury.
Can also produced by direct trauma over the ulnar
border of the forearm.


FRACTURE OF THE SHAFT OF THE
RADIUS AND ULNA
Treatment :
Adult
ORIF
ELBOW AND ARM
1. # OLECRANON
Commonest type is
due to a fall with
passive flexion of the
elbow combined
with powerful
contraction of the
triceps muscle.
Treatment :
ORIF using TBW
(Tension Band Wire)
ELBOW AND ARM
2. # OF THE RADIAL HEAD
Relative common
Young adults
Caused by a severe valgus
abduction force applied to the
extended elbow
Radiographic Examination:
# radial head

ELBOW AND ARM
Treatment :
Depends upon the severity of the damage to the radial
head
undisplaced # : only protection, immobilized with sling for
2 weeks
Depressed & comminuted # : excision of the entire head
of the radius
Complication :
Post traumatic degenerative joint disease of the elbow


POSTERIOR DISLOCATION OF THE ELBOW
MECHANISM OF INJURY :
Fall on the hand with the
elbow slightly flexed
Severe Hyperextension injury
of the elbow
CLINICAL FINDING :
Swollen elbow is held in a
position of semi flexion
Olecranon is readily palpable
posteriorly
RADIOGRAHIC EXAMINATION :
Dislocation.

POSTERIOR DISLOCATION OF THE ELBOW
TREATMENT:
Closed Reduction
Immobilization by cast for at least 3 weeks
COMPLICATION :
Elbow stiffness
Median nerve injury
FRACTURE DISLOCATION OF THE ELBOW
Side swipe injury :
Occurs when a driver has his elbow out the open
window of a car at the moment the car is struck
from the side by another vehicle.
Usually :
Elbow dislocation
Multiple comminuted # of the humerus, radius &
ulna
Treatment :
Wait until soft tissue healed
ORIF
FRACTURES OF THE SHAFT OF THE
HUMERUS
> adults
Direct trauma # transverse / comminuted
Indirect trauma fall on the hand # spiral
Clinical Examination :
Flail arm
Patient tries to support with the opposite hand, Radial Nerve lesion
should always be sought and its presence or absence recorded at the
time of the initial examination
FRACTURES OF THE SHAFT OF THE
HUMERUS
Treatment :
Closed treatment
Indication for ORIF if injury of Brachial artery
which necessitates arterial repair
TRANSVERSE # OF THE HUMERAL SHAFT:
Anaesthesia reduction U Slab (Sugar Tong Splint) /
Hanging Cast
Clinical union achieved within 6 weeks

FRACTURES OF THE SHAFT OF THE
HUMERUS
# SPIRAL & COMMINUTED FRACTURES :
Do not require reduction / anaesthesia
Gravity alone is adequate to provide alignment of the
fracture fragment
immobilized in U shaped plaster slab

COMPLICATION :
Radial Nerve Injury
Delayed Union
Non Union
FRACTURES OF THE NECK OF THE
HUMERUS
In elderly persons, especially
Impacted # relatively common
Treatment :
only protection from further injury by
a sling during 6 weeks required for union
SHOULDER JOINT
1. Shoulder Joint Dislocation
Anterior Dislocation of the Shoulder
Predominantly of young adults
Caused by forced external rotation and extension of the
shoulder
Radiographic examination : confirm the diagnosis
Treatment :
Reduce as soon as possible, methods :
Kocher Method
Gravitation
Hipocrates
After reduce must immobilized by Velpeau Bandage
SHOULDER JOINT
2. Recurrent Anterior Dislocation of The Shoulder :
The stability of the shoulder depend on the integrity of the
joint capsule capsule, capsule & anterior labrum are nearly
always avulsed caused the dislocation may recur more and
more frequently with less and less violence.
Treatment :
Surgical repair with Putti Platt operation capsule as well as the
Subscapularis muscle are divided and then refeed (overlapped)
limiting external rotation.


SHOULDER JOINT
3. Posterior Dislocation of the Shoulder
Less common than anterior dislocation
Posterior dislocation can occur :
Fall on the front of the shoulder, with shoulder adducted and
internally rotated
Clinical Finding :
The patients arm seems locked in a position of adduction and
internal rotatted
Radiographic finding:
Not readily detected in an AP projection, need special examination :
Superoinferior (axillary) projection with the shoulder abducted, is
necessary to confirm that the humeral head is in fact lying posteriorly
Treatment :
Closed reduction
SHOULDER JOINT
4. Acromioclavicular Joint
Dislocation (AC Joint)
Complains of severe pain over the
shoulder
Local tenderness (+) overthe AC
joint
Radiolographic examination:
Patient standing and holding a
weight in each hand.
SHOULDER JOINT
Treatment :
Non operatif : Kenny-Howard Sling, depress the
clavicle and elevate the acromion
If failed ORIF, capsult repair, insertion of a K-
wire
K-wire removed after 6 weeks
SHOULDER JOINT
5. FRACTURE OF CLAVICLE
Common site is the middle third of the clavicle
Lateral fragment pulled inferiorly and medially by the
weight of the shoulder and upper limb
Treatment :
Figure of 8 padded bandage
Clinical united in 3 weeks
Complication
Malunion
Delayed union
Nonunion relative rare
FOOT
1. # OF THE METATARSAL
>>common #
Drop by heavy objects
Run over injury with a metal wheel
Important: impairment of circulation to the forefoot
Treatment :
multiple # K-wire fixation
4 weeks NWB walking cast worn for additional
4 weeks
FOOT
2.CALCANEAL #
Fall from a considerable height onto one or both heels.
High incidence of associated compression # of the spine
Treatment
extra-artikular # :
Under anaesthesia the two major fragments should
manually compressed from side to side walking cast
for 6 weeks
intra-artikular # :
ORIF
FOOT
3. FRACTURES OF THE NECK OF THE TALUS

No muscle attached to talus
> covered by articular cartilage
Blood supply not to good
# neck talus correlate with incidence of avascular
necrosis (the body) and non union
FOOT
Mechanism of trauma
Severe dorsoflexion injury as may be incurred when the
driver has his foot hard on the brake pedal at the moment of
a head-on collision
Treatment :
Closed reduction BK cast for at least 8 weeks
Complication:
Avascular necrosis
Degenerative joint disease
Nonunion


THE ANKLE
# & # DISLOCATIONS OF THE ANKLE
1. Isolated # of the Medial Maleolus
Abduction injury avulse medial
maleolus below the joint line

Adduction injury shear off the medial
maleolus above the joint line

Treatment :
Undisplaced : BK cast for 8 weeks
Displaced : ORIF
ANKLE
2. Isolated # of the Lateral Maleolus
Abduction / external rotation injury
Most common injury of the ankle
Treatment :
Closed reduction stable immobilized in
BK Cast for 6 weeks
NWB 3 weeks
ANKLE
3. Bimalleolar #
(# of both medial & lateral
malleolus)
Severe injuries of the
abduction or external
rotation
Treatment :
closed reduction
unstable ORIF
4. Trimalleolar #
Treatment :
ORIF
ANKLE
Complication :
Joint stiffness
non-union rare
>> malunion sbg hsl dari loss of correction dari
fragmen #
Degenerative joint disease

LOWER EXTREMITY
# OF THE SHAFTS TIBIA & FIBULA
> fractured more frequently
Periosteum is thin in adult
Frequency open #
Rate of union slow
Mechanism of injury :
Direct trauma bumper, Traffic accident
Clinical features :
Swelling, deformity, Tenderness
Radiographic : AP / Lateral
LOWER EXTREMITY
Treatment
Reduction of the tibia
Oblique & transverse # closed reduction
Clinical Union after 3-4 weeks
Unstable oblique # & spiral # ORIF
Complication
Ankle stiffness
Nerve injury
Delayed union
Non-union
malunion

KNEE JOINT
1. # of the proximal end of theTibia ( Bumper #)
Mechanism of injury :
Usually in elderly
A severe abduction injury, usually a direct blow on the lateral
aspect of the limb with the foot fixed on the ground.
Treatment:
Closed reduction for elderly
If the patient young ORIF

KNEE JOINT
2. Traumatic Dislocation of the knee joint
Torn of 4 major ligaments :
CML
CLL
ACL
PCL
Complication:
Trauma of the Popliteal Artery
risk of gangren in the distal part
Treatment:
Reduced as soon as possible
Complete Dislocation of the
knee joint
KNEE JOINT
3. FRACTURES OF THE PATELLA
Indirect :
Tears of the Quadriceps expansion at the level of the patella
produce transverse avulsion fracture of the patella
Direct :
Direct trauma comminutted
Clinical finding :
Patient cant extent the lower extremity
Treatment :
TBW

KNEE JOINT
4.INTERCONDYLAR FEMUR #
Patient fall (knee in flexion position) from
height.
Clinical finding : swelling >>
Radiolographic :
Treatment :
ORIF
FEMUR
FRACTURES OF THE FEMORAL SHAFT
Clinical features:
swelling >>
deformity
Radiographic examination :
Done after ABC stabile


FEMUR
Treatment:
1. Nonoperative treatment :
Longer period in the hospital
Longer period of weight bearing
Continuous traction (12 weeks )

Clinical union
active exercise, non weight bearing
Radiological union

Weight bearing
2. Operative treatment :
ORIF with intramedullary nail
FRACTURES OF THE FEMORAL SHAFT
Indication for intramedullary nail # of the femur :
1. Fail in Closed reduction
2. Multiple trauma (head trauma)
3. Femoral Artery injury need to repair.
4. Elderly, prolonged bed rest is deleterious
5. Pathological #
Complication :
Shock
Fat embolism
Knee stiffness
Non-union
PELVIS
1. TROCHANTERIC # OF THE FEMUR
Include:
Intertrochanter # ( # between the lesser and greater
trochanters)
# through the trochanter pertrochanteric #
> common in adults over the age of 60 years
>
Clinical features
Lower limb complete external rotation
Extremity appears short
Upper part of thigh is swollen
PELVIS
Radiolographic examination:
extent of the #
Treatment :
ORIF
Nonoperatif
Complication:
Malunion nonoperatif
NECK FEMORAL FRACTURE
1. Subcapital
2. Transcervical
3. Basilar
Garden classification :
4 type (intracapsular)
Type 1 : incomplete
Type 2 : complete, undisplaced
Type 3 : partially displaced
Type 4 : complete displaced
NECK FEMORAL FRACTURE
Treatment :
Operative : Hemiarthroplasty for the elderly
patient
Complication:
Avascular necrosis femoral head
Non-union > 30%
TRAUMATIC DISLOCATION &
# DISLOCATION OF THE HIP
1. POSTERIOR DISLOCATION
Position:
Flexion & adduction, internal rotation
Usually caused by dashboard injury
Extremity became shortens

TRAUMATIC DISLOCATION &
# DISLOCATION OF THE HIP
Treatment:
Closed Reduction
Methods
Complication :
Avascular necrosis
femoral head
Sciatic nerve lesion
Post traumatic
degenerative joint disease

TRAUMATIC DISLOCATION &
# DISLOCATION OF THE HIP
2. ANTERIOR DISLOCATION
Less common
Caused by a violent injury which
forces the hip into extension,
abduction and external rotation.
Radiographical finding:
head femur below the acetabulum
TRAUMATIC DISLOCATION &
# DISLOCATION OF THE HIP
Treatment :
Closed reduction as soon as possible
Applying traction on the flexed thigh and then
internally rotating and adducting the hip.
After reduction, the patient hip should be
immobilized in a Hip Spica Cast in its most stable
position ( flexion, adduktion, internal rotation)
TRAUMATIC DISLOCATION &
# DISLOCATION OF THE HIP
1. Full flexion
2. Adduction of the hip
3. Internal rotation
4. Extension
5. Neutral position