A New Effective Approach to the Hip (for Old Unreduced Dislocation)

Abstract

In Vietnam, Incidence of Old Unreduced Hip Dislocation may account for up to 20%. Old Dislocation is defined as older than 3 weeks not relocated. Inside the dislocated hip, develop many inflammatory tissues such as granulation, fibrous with injured a surrounding structure (capsule, ligaments, tendons, bony pieces etc...) which filled up the acetabulum, prevents the head to be relocated. Over effort to reduce closely an old hip dislocation risks fracture of neck or trochanteric femur. In this case, open reduction is almost mandatory. There are many approaches to access and relocate a dislocated hip, we propose a new one which enables surgeon to expose the acetabulum, to liberate the femoral head, reconstruct the defect of acetabulum and /or femoral head and relocate the hip. Skin incision in shape of S for the left hip, in shape of Z for the right hip, from iliac wing to trochanter, then along the femoral shaft. Figure1 Follow strictly on the bone of lateral iliac wing, go posteriorly will find out the acetabulum; determine the anterior border of Gluteus Medius, dissect the muscles toward greater trochanter, and get complete exposure of operative field. Femoral head is found out & liberated from surrounding tissue. Clear up the acetabulum, reconstruct the bony lesions. Relocate the femoral head in acetabulum, and stabilize with a K-wire. The hip is often immobilized with a Spica casting for > 3 weeks.