Internal fixation for central dislocation of the hip

The femoral head hits the acetabulum, the head can be broken, and a central dislocation occurs. In severe cases, the pelvis can be broken into the pelvis, and the head is embedded in the card, which cannot be pulled and reset. Due to the pelvic fascia and iliopsoas muscle barrier, viscera and blood vessels are rarely injured. Such injuries are more serious, and attention should be paid to the presence or absence of concurrent injuries, including fractures of the pelvis and bladder, urethra, and nerve damage. Simple incomplete dislocation can be towed, including lower femoral condyle traction and large trochanter penetration into the femoral neck to pull outward to recover. However, if the closed reduction is unsuccessful, the operation is adapted. Curing disease: Indication 1. The femoral head is embedded in the basin, hindering the manipulation. 2. The fracture piece is embedded in the dome. 3. The traction cannot be used to reset the dome flap. 4. The ipsilateral femoral shaft fracture can not be pulled and reset. Surgical procedure Incision Commonly used in the groin approach, the anterior incision, from the posterior 1/3 of the iliac crest, the anterior superior iliac spine obliquely to the midline, ending at the pubic symphysis. Depending on the extent of the fracture, it is sometimes necessary to have a front and a back incision at the same time 2. Reveal The anterior wall muscle was cut along the iliac crest, and the iliac crest muscle was peeled off from the inner side of the iliac crest, until the edge of the true pelvis, the fracture and dislocation were revealed, and the gauze was stuffed to stop bleeding. Parallel to the upper 2 cm of the inguinal ligament, the aponeurosis and subcutaneous loop of the external oblique muscle were incised, the inguinal canal was incised, the spermatic cord was separated, and protected. The junction of the internal oblique muscles and the transverse abdominis muscles and the groin was cut along the upper edge of the inguinal ligament, and the iliopsoas muscle sheath was exposed to find the femoral nerve and protect it. When the internal oblique muscle of the anterior iliac spine is attached to the lower edge of the transverse abdominis muscle, the lateral femoral cutaneous nerve is prevented from being injured. The diaphragm was peeled off along the edge of the true pelvis until it was fully revealed. The iliac crest and the transverse abdominis membrane are separated from the medial part of the iliac crest, which enters the posterior pubic space. If necessary, the rectus abdominis can be cut 1 cm above the upper edge of the pubis. If necessary, pull the iliopsoas, femoral blood vessels, spermatic cord and femoral nerve in different directions to reveal the desired site. 3. Repair fracture and dislocation One or two bone round needles (Steinmann needles) were drilled into the ankle joint for traction to the midline. Make a small incision on the outside of the femoral trochanter, introduce the femoral head retractor into the femoral neck through the large trochanter, and use the lateral traction frame on the assistant or operating table to maintain the traction laterally, or in the front and rear direction of the large trochanter. Wear the needle and connect the traction bow to pull. Another needle is pulled down the upper part of the femoral condyle. 4. Internal fixation After the satisfaction is revealed, the femoral head is pulled out, and the fracture is repaired by means of a rongeur, and the fracture piece is directly pushed back in place, or the fracture line is inserted into the fracture line to assist in the reduction. Use a towel clamp or a rongeur to cross the fracture line for temporary alignment, and then screw the fracture piece to the lid. And apply the steel plate according to the need, the plate must be in close contact with the bone surface, and the screw is fixed on the upper or inner surface, the sacral line, the ankle joint, the pubic symphysis, the ischial tuberosity and the like. 5. Close the wound The suture was sutured according to the anatomical level, and the drainage was placed in the concave and posterior pubic space The abdominal muscles, such as the rectus abdominis, have been sutured and the muscle sheath should be repaired. After the vascular nerve was not damaged, the intra-abdominal oblique muscle and the transverse abdominis muscle were sutured on the inguinal ligament, the spermatic cord was placed back in place, the bleb of the external oblique muscle was sutured, and the inguinal canal was repaired.

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