Pathology of hip disruption

2021-01-30 12:00 AM

Chi is dislocated completely, with palpable pelvic type detected the raised nodule higher than the NĂ©laton - Roser line, thus showing signs of the short limb.

 

Outline

Less common hip dislocations account for about <5% of total dislocations. The male / female ratio is 5/1.

In adult’s hip dislocation due to major trauma occurs due to an indirect force applied to the head under the femur, and the knee area when the thigh is folded, rotated in and closed, the knee joint is in a folded position. The force transmitted through the femur body pushes the upper end of the joint to the back joint and pushes to the pit of the joint, causing the sac to tear and up to 40% of cases are broken. The femoral tip popped out and broke the round ligament.

Classify

Sort by order of order

Depending on the position of the cusp compared to the muzzle we distinguish 3 types.

Come back: Very common, 80% or more.

Fall back up to make up most of it is called pelvic dislocation.

Falling back and forth is called a sitting dislocation.

Pre-emergence: Uncommon accounts for about 10% of the total hip dislocation.

Spread out first is called pubic style.

Spread out first and down is called seal type.

Central defect

The base of the hollow joint is broken. This dislocated cap is moved deeply to the bottom of the hollow joint due to two reasons.

Due to the force exerted on the large displacement jig, the elbow inward broke the base of the muzzle, which was severely damaged. This group accounts for 55%.

Due to the rupture of the pelvis (the part of the pelvis in the hollow of the joint), the cap is easily displaced inward and the tip is less susceptible to damage.

Due to both above reasons: Meet 3 - 5% of the central deviation.

Classification by weight

Based on bone damage and hip joint strength.

Grade 1: Heal joint or just a little chipped does not cause any sequelae.

Grade 2: The concave joint is broken in the posterior wall but when the joint is clinically strong.

Grade 3: The posterior wall of the hollow joint is heavily broken after manipulation, the joint is not strong enough, easily dislodged, needs surgery to fix the fracture in the posterior wall of the hollow.

Grade 4: With a femoral head or neck fracture.

Clinical examination

Although there are many types of dislocations as mentioned above, but in reality, clinically there is only one common type that is back-up on the pelvis.

Look

The thighs are slightly folded, closed and turned inward, the limbs are shorter. The lateral pillow went higher and was like leaning on the good knee.

General signs indicate the types of deviations:

Types of dislocations: The thighs are closed and turned inward.

Types of lopsided front: thigh shape and rotating out.

Types of dislocations up (pelvic, pubic), thighs are lightly folded with signs of short limb.

Types of dislocation below: (Sitting type, seal type) thighs are folded much, signs of short limbs are not clear, even limbs are longer.

Through these general signs, it is easy to see the clinical signs of a certain type.

Although there are many types of dislocations as mentioned above, in clinical practice the most common type is the pelvic dislocation: the thighs slightly folded, closed and rotated in, the limbs are shortened. The lateral pillow went higher and was like leaning on the good knee. Dislocated thigh-shaped type, rotated the outer thigh many limbs not short but as long.

Touching and physical examination

Chi is dislocated completely, with palpable pelvic type detected the raised nodule higher than the NĂ©laton - Roser line, thus showing signs of short limb.

X-ray

Need to have x-ray of the pelvis and hip joints in a straight position. If there is a small abnormality in the cavity of the joint, take a scan of 450 back inwards to detect fragments behind the hollow joint.

Symptoms

Nerve damage

With posterior dislocations with fracture can be complications of the paralysis of the hip, the rate is from 1 to 33%.

Need to examine the signs of movement paralysis in the feet and loss of sensation in the soles of the feet.

If the hip joint does not rupture the enlarged hip nerve is paralyzed due to tension, bending, or compression between the cap and the seat, the paralysis is usually mild.

If the joint cavity ruptures and the nerve paralysis is usually due to surgical damage (partial rupture, complete rupture). Should be operated early to suture nerve.

Dislocations with fractures

Broken back.

With femoral neck fracture: Often surgery is required to manipulate the cap and fix the fracture with a nail or brace.

The most common classification of hip dislocation is that of Thompson and Epstein:

Type 1: hip fracture with or without a rupture of a bowl. Firm back

Type 2: T very hip with big powerful shore break following an acetabulum. Unwavering.

Type 3: Dislocations of the hip with many fragments of the back bank of the jar.

Type 4: Dislocations of the hip with a broken bearing floor.

Type 5: hip fracture with neck fracture of femur.

Treatment

Dislocations coming soon. Boehler manipulation: applies to all types of hip dislocation.

Deep anaesthesia is required for muscle relaxants. Have the patient lie on his back on a long board. The hip bowl is fixed. Groin and pillow 90 0 . Fold a twisted cloth in figure 8. One end wrap around the top

 the patient still has one end hanging from the curler's neck. The manipulator knelt down next to the patient on the dislocated side so that the knee along with the dislocated joint into the knee of the patient.

Add one lower hand holding the patient's leg down, thus pushing the patient's knee up. Just pull hard enough to put the cap into the joint. If not, help more by correcting the dislocated position.

If the deflection follows the thigh shape and rotate outward - If the deflection comes first, close the thigh and rotate inward.

After 3 weeks immobilizing the powder to heal the torn joint and ligament.

Preventive

Propaganda and education in the community about traffic and labour laws.

Need to educate the community to first aid on the spot and well immobilize cases of dislocations.

For the grassroots health facilities, early diagnosis, correct handling and early manipulation of the joint are required.

Educate patients on rehabilitation exercises after treatment.

Educating the community should not do massages and manipulations or prisms in traditional healers.