If the femur head is dislocated, it should be reduced as soon as possible, to prevent damage to its blood supply. This is preferably done under anaesthesia, following which, leg is kept pulled by applying traction to prevent joint from dislocating. The final management depends on the size of the fragment(s), stability and congruence of the joint. In some cases traction for six to eight weeks may be the only treatment required; however, surgical fixation using screw(s) and plate(s) may be required if the injury is more complex. The latter treatment will be called for if bone fragments do not fall into place, or if they are found in the joint, or if the joint itself is unstable. Post-surgery Depending on the stability achieved via initial treatment, the patient may be allowed to stand and walk with help of support within about six to eight weeks. Full function may return in about three months. Principles of management At the site of injury: After stabilizing an injured person and resuscitation, quick examination is done to check injury to vital organs. If one suspects injury to the hip, it is imperative to immobilise the limb using some kind of support to prevent movements of the injured limb to prevent further damage A trained paramedic may be able to diagnose hip dislocation by noticing the position of the injured limb. It is essential to document status of nerves and vessels before starting any treatment to protect oneself from litigation On arrival at the hospital, trained trauma surgeon will assess the patient and prescribe necessary tests including x-rays as described earlier. Non-surgical management consists of reducing the dislocated joint by maneuver under anaesthesia and applying traction to the limb to maintain position of joint and fractured bones. If non surgical management is preferred it may require six weeks to 3 months for recovery. Surgical management The surgical management requires high degree of training and well equipped centre. It should be carried out by experienced surgical team to get best results. The principles laid down for management are; * Anatomic reduction of the fractured fragments * Stable fixation * Congruent joint * Early mobilization * Delayed weight bearing Innominate bone is a flat bone with many curves. In most part the bone is thick enough and has broad surfaces that are amenable to primary fixation using lag screw(s) and to neutralize forces across the bone one needs to add plate(s) on the surface of the fractured fragments for it to heal without deformity. Before surgery, patient needs tests to check fitness for surgery Anaesthesia : the surgery may be performed either under regional anaesthesia or general anaesthesia Surgical approaches. Following are the common approaches; * Kocher Langenbeck approach for posterior injuries * Ili inguinal, Ilio femoral of modified stoppa’s approach for anterior or combined injuries Implants : normally lag screws and reconstruction plates are preferred implants Post operative management: would involve initial period or bed rest, followed by mobilisation by trained therapist Total time to recover may be up to 3 months
Acetabular fracture
Sacral fracture
Hip dislocation
Hip fracture
Knee dislocation
Femoral fracture
Humerus fracture
Jefferson fracture