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Chapter-15 Neglected Traumatic Dislocation of Hip

BOOK TITLE: Neglected Musculoskeletal Injuries

Author
1. Jain Anil K
2. Kumar Sudhir
3. Agarwal Aditya
ISBN
9788184488890
DOI
10.5005/jp/books/11171_15
Edition
1/e
Publishing Year
2011
Pages
7
Author Affiliations
1. University College of Medical Sciences and Guru Teg Bahadur Hospital Delhi, India, University College of Medical Sciences and GTB Hospital Delhi, India; Indian Journal of Orthopaedics, University College of Medical Sciences and GTB Hospital Delhi, India Editor, Indian Journal of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
2. University College of Medical Sciences and GTB Hospital, Delhi, India, Apollo Hospital, Hyderabad, India, University College of Medical Sciences Shahdara, Delhi, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India, School of Medical Sciences and Research Sharda University, Greater Noida, Uttar Pradesh, India, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
3. University College of Medical Sciences and GTB Hospital, Delhi, India, Medanta—The Medicity, Gurugram, Haryana, India
Chapter keywords

Abstract

The neglected traumatic dislocation of hip in children and adults are uncommon. The various treatment modalities in adults include closed reduction, open reduction, heavy traction in abduction, intertrochanteric/subtrochanteric osteotomy, girdlestone excision arthroplasty, arthrodesis, hemiarthroplasty and total hip replacement. The closed reduction can be achieved following injuries less than 3 weeks old. Beyond 3 weeks closed reduction with heavy traction is attempted failing which open reduction is advocated. The presence of associated fracture of acetabulum should also be fixed. Open reduction is required for all dislocation beyond 12 weeks failing which reconstructive procedures such as total hip arthroplasty or arthrodesis are indicated depending on the social need and acceptance by the patients. Those late reconstructive procedures may be technically difficult because of extensive scaring, shortening, avascular necrosis of the femoral head and acetabular disruptions. Neglected traumatic dislocation of hip in children is rare. They occur following a trivial fall hence missed. Closed reduction may be attempted with caution in dislocation less than 3 weeks old. It is difficult to achieve closed reduction with heavy traction if dislocation is more than 3 weeks old. Open reduction is advisable to restore anatomy for neglected dislocation of any length of time knowing fully well that almost all of them will develop avascular necrosis. Still the remodeling and revascularization gives good clinical result.

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