EXAMINATION TECHNIQUE

OF OPEN ANTERIOR
DISLOCATION OF THE HIP
By Khansa Qonita R amadhani
P1337430216010
INTRODUCTION
Anatomy of Hip Bone
The hip bone (os coxa, innominate bone, pelvic bone or
coxal bone) is a large flat bone, constricted in the
center and expanded above and below. In some
vertebrates (including humans before puberty) it is
composed of three parts: the ilium, ischium, and the pubis.
The two hip bones join at the pubic symphysis and
together with the sacrum and coccyx (the pelvic part
of the spine) comprise the skeletal component of the
pelvis – the pelvic girdle which surrounds the pelvic
cavity. They are connected to the sacrum, which is part
of the axial skeleton, at the sacroiliac joint. Each hip
bone is connected to the corresponding femur (thigh
bone) (forming the primary connection between the
bones of the lower limb and the axial skeleton) through
INTRODUCTION
Structure of Hip Bone
1. Sacrum
2. Ilium
Hip Joint
3. Ischium
4. Pubic Bone
5. Pubic symphisis
6. Acetabulum
7. Foramen obturatum
8. Coccyx
DESCRIPTION
Dislocation of the hip is a common
injury to the hip joint. Dislocation
occurs when the ball–shaped head of the
femur comes out of the cup–shaped
acetabulum set in the pelvis. This may
happen to a varying degree.
A dislocated hip, much more common
in females than in males, is a condition
that can either be congenital or
acquired.
Case Report
Male patient, 46 years old, victim of an automobile
accident, was ejected from the vehicle. He was
admitted in our hospital about an hour after the
injury, brought by the rescue team.
On examination, the following were observed: he
was conscious and hemodynamically stable; with a
wound of about 10 cm on the left inguinal region,
cross position, with exposure of the left femoral
head; hip in extension, abduction and external
rotation ; distal pulses present and, apparently, no
signs of neurological impairment in the affected limb.
Cont’

Fig. 1. Appearance of wound at the root of the left thigh, exposing

the femoral head
Radiology Medical Technique
Preparation of tools and materials
 X-ray
Examination Table
IP size 35 x 43 cm
CR
Shields gonad
Soft bag
Marker
Grid
Cont’
Preparation of Patient

For open anterior hip dislocation there is no

important preparation. Patient is required to
change the clothes with the patient’s clothes
IMPLEMENTATION OF THE
EXAMINATION
AP PELVIS
PROJECTION
(BILATERAL HIPS)
RESULT
The initial radiographs
revealed high anterior
dislocation of left hip (Fig.
2) and fracture of the left
clavicle; no visceral injury
was detected.

Fig. 2. AP radiograph of the pelvis demonstrating

anterosuperior dislocation of the left hip, with
prominence of the lesser trochanter.
Cont’

The patient was sent to the operating room two hours

after admission. A lesion of the proximal rectus femoris
muscle was viewed. Cleaning and debridement of the
wound were made; the joint reduction was done by
traction and internal rotation, without difficulties.
Clinical and radiographic evaluation revealed a stable
reduction (Fig. 3). The wound was closed with
introduction of broad‐spectrum antibiotics for 72 h.
Wound healing without need for further debridement
occurred.
Cont’

Fig. 3. Postreduction radiograph showing left hip joint congruency.

DISCUSSION
Anterior traumatic hip dislocation is a rare injury. The
injury is classified according to the position taken by
the femoral head: pubic (high) and obturator (low).
Biomechanical studies on cadavers have shown that
extension, abduction and external rotation of the hip
produces pubic dislocation with the femoral head
positioned in front of the horizontal ramus of the
pubis, with possibility of laceration of pectineus and
iliopsoas muscles and of injury to the neurovascular
bundle.
CONCLUSION

In cases of closed anterior dislocation, the risk of

avascular necrosis varies from 1.7% to 40% in different
series. In the case of open dislocations, there was
osteonecrosis of femoral head in five of nine cases (of
the ten cases previously described in the literature, one
case of death in the immediate postoperative period was
excluded). Of these five cases, three were associated with
deep infection.
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