Dislocations and Femoral Head Fractures髋关节脱位股骨头骨折ppt课件.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * 2. Hip Dislocation with Femoral Neck Fracture Usually the dislocation is posterior. Thus, Kocher-Langenbeck approach. If fracture is non-displaced, stabilize fracture with parallel lag screws first. If fracture is displaced, open reduction of femoral head into acetabulum, reduction of femoral neck fracture, and stabilization of femoral neck fracture. 3. Incarcerated Fragment Can be detected on x-ray or CT scan. Surgical removal necessary to prevent abrasive wear of the articular cartilage. Posterior approach allows best visualization of acetabulum (with distraction or intra-op dislocation). Anterior approach only if: dislocation was anterior and, fragment is readily accessible anteriorly. 4. Incongruent Reduction From: Acetabulum Fracture (weight-bearing portion). Femoral Head Fracture (any portion). Interposed tissue. Goal: achieve congruence by removing interposed tissue and/or reducing and stabilizing fracture. 5. Unstable Hip after Reduction Due to posterior wall and/or femoral head fracture. Requires reduction and stabilization fracture. Labral detachment or tear Highly uncommon cause of instability. Its presence in the unstable hip would justify surgical repair. MRI may be helpful in establishing diagnosis. Results of Treatment Large range: from normal to severe pain and degeneration. In general, dislocations with associated femoral head or acetabulum fractures fare worse. Dislocations with fractures of both the femoral head and the acetabulum have a strong association with poor results. Irreducible hip dislocations have a strong association with poor results. 13/23 (61%) poor and 3/23 (13%) fair results. McKee, Garay, Schemitsch, Kreder, Stephen. Irreducible fracture-dislocation of the hip: a severe injury with a poor prognosis. J Orthop Trauma. 1998.  Complications of Hip Dislocation Avascular Necrosis (AVN): 1-20% Several authors have shown a positive correlation bet