Posterior dislocation of hip with open reduction of acetabular fracture

According to the position of the femoral head after hip dislocation, the hip dislocation can be divided into three categories: 1 anterior dislocation of the hip: the dislocation of the femoral head stays in front of the iliac crest and the ischial tuberosity. 2 posterior dislocation of the hip joint: after the dislocation of the femoral head, stay in the sacral and ischial tuberosity connection. 3 hip dislocation: the femoral head is pushed by the violent acetabular center, breaking through the acetabular floor or penetrating the fracture of the acetabular floor and protruding into the pelvic cavity. Among the three types, posterior dislocation of the hip is the most common. Fresh hip dislocation sputum should be closed and reset in time, such as the successful closure of the closure due to hip rupture of soft tissue, or the filling of the acetabulum; or combined with acetabular fractures, fractures hinder resetting, or due to The fracture piece is large, although the reduction, but the femoral head can not be stabilized in the acetabulum, and the central type of dislocation with pelvic internal organ damage and other serious complications, surgery should be performed open reduction. Curing disease: Indication 1. The acetabular margin fractures are large and the reduction is poor. 2. The acetabular rim fracture is located in the acetabulum. When the maneuver is reset, the fracture piece cannot be accompanied by the reduction, and the femoral head is prevented from being reset. 3. After a transverse fracture of the acetabulum, the fracture block rotates, thus hindering the reduction of the femoral head and causing acetabular irregularities. Preoperative preparation 1. The affected limb sustained bone traction for 7-10 days. 2. Carefully check whether the sciatic nerve has combined damage. 3. Preparation of blood 800 ~ 1200ml, such as lower blood pigment before surgery, should be appropriate to add before surgery. Surgical procedure 1. Incision revealed The posterior incision of the hip was used. The incision started at about 5 cm below the posterior superior iliac spine, paralleling the direction of the gluteus maximus fibers to the posterior superior angle of the femoral trochanter, and then extending 5 cm down the posterior margin of the femoral trochanter. Open the superficial and deep fascia, separate the gluteus maximus fibers from the upper part of the incision, and divide it outwards to the posterior part of the iliac crest. Cut the gluteus maximus on the fascia and the incision. 5cm, the gluteal muscles separated by blunt distraction, the sciatic nerve and the external muscle of the hip are displayed in the surgical field; in the hip, the piriformis, supraorbital muscle, obturator muscle and infraorbital muscle The tendon is cut in close proximity to the femur-sized trochanter, and the above muscles are turned inward to protect the sciatic nerve. At this time, the posterior side of the hip joint capsule has been revealed. 2. Reveal the acetabular fracture block and fix the internal fixation screw Cut the switch sac in the direction of the longitudinal axis of the femoral neck, expose the posterior edge of the femoral head femoral neck and the acetabulum, and retract the gluteus medius and the femoral muscles respectively to the upper part of the sac. After the anatomical reduction of the fracture block, use a suitable length of the screw to point to the midline of the iliac crest, and fix it obliquely upwards. Be careful not to penetrate the articular surface when entering the nail. If the fracture block is small and displaced into the acetabulum, it is removed. If the small fragments of the femoral head are not removed, the femoral head is often prevented from being completely repositioned and should be removed. As for the treatment of large fractures from the surface of the femoral head, the opinions are not the same. There is a claim that the anatomical reduction should be fixed with a screw. The nail head should be deep under the cartilage of the femoral head fracture block, but there are also It is better to remove the fracture block than to restore the fracture block. The reason is that even if the fracture block is returned, the ischemic necrosis will not occur in the future, and the hip will be stimulated and the hip will be triggered and accelerated in the future. The root cause of joint traumatic arthritis. If the acetabular floor fracture is caused by the rotational displacement of the distal part of the hip, the acetabular joint surface is uneven. The periosteal stripper can be inserted into the fracture joint to correct it. 3. Suture the incision according to the level. complication 1. After traction for 6 weeks, if the acetabular fracture block is fixed firmly, remove the traction after 6 weeks and start the active activity of the hip joint; if the femoral head fracture is combined, the hip active exercise will be carried out after 6 weeks of traction, 12 weeks The rear can be gradually loaded. 2. The quadriceps exercise should be started as soon as possible after surgery.