Hip injuries consist of injuries to acetabulum, lower pelvis, intertrochanteric fractures, fracture of neck of femur, fracture of femoral head, subtrochanteric fractures and hip dislocations.
A collection of xrays and clinical photographs of hip injuries is being presented.
Image 1 – Xray of Oblique Subtrochanteric Fracture of Femur With Dynamic Hip Screw and Interfragmentary Screw
DHS and Interfragmentary screw in subtrochanteric fracture
Subtrochanteric factures are fractures below the intertrochanteric line of femur. These are high velocity fractures and quite common in young active adults.
The xray in the picture is of a 43 years old man who sustained this fracture after fall from height.
The xray is one month following the surgery and fracture is showing union in most of its surface.
Fractures of subtrochanteric region are not amenable to surgical treatment and are treated by operative methods.
Image 2 -Uppper Femoral Fracture In 3 Years Old Child -Anteroposterior Xray
Fracture of upper end femur form around 1% of paediatric fractures. They are caused by high energy trauma.
This xray is of a 3 years old child who suffered fracture of upper end of femur after he was struck by a bus. The child had presented to casualty with pain and swelling. There was associated tachycardia and anemia.
The xray of the child showed a displaced fracture of upper end femur. The child was put on Long Liston splint and
was operated for injury. Open reduction and internal fixation was carried out using dynamic compression plate and screws.
Child was put on double hip spica and had an uneventful postoperative period.
Image 3 – Undisplaced Fracture Of Neck Of Femur Xray
Undisplaced fractures of neck of femur are not common in adults. Recently a man of 37 years of age collided his bike with a tractor that was coming from opposite side and suffered many injuries which included fracture of upper end right humerus, open comminuted fracture of lower end of femur of right side and undisplcaed fracture of ipsilateral neck of femur.
The person was operated upon immediately for temporary stabilization of open femoral fracture and splint was applied to upper arm injury.
The patient is yet to undergo definitive surgery.
Image 4 – Periprosthetic Fracture Shaft of Femur in a Patient with Bipolar Hemiarthroplasty
Periprosthetic fractures are fractures that occur around the implants of joint replacement.
Following xray is of 82 years old male who had undergone bipolar hemiarthroplasty for fracture of neck of femur about 3 years before this episode.
he was brought to the hospital after complaint of increased thigh pain following fall while walking. Xray revealed the implant and a fracture in the femoral shaft around distal part of the stem.
The fracture was undisplaced and was managed non operatively after patient chose the non operative means of treatment. The fracture united uneventfully.
Image 5 – Fracture Bilateral Neck of Femur In A Woman With Post Polio residual Paralysis
25 years old female presented to the OPD with complaint of pain in left hip region. She walked with a bilateral lurching gait.
Examination revealed bilateral lower limbs which appeared hypotrophied with right more than left. Hip movements were exaggerated in all the planes and both hips were found to be unstable.
The xray revealed following picture.
The xray shows old fracture of neck of femur on both the sides. Bilateral acetabuli are malformed and right femur is more hypoplastic than left.
There was no history of any trauma.
A diagnosis of long standing bilateral neck femur fracture with probable cause as childhood osteomalacia was made.
Patient was managed on analgesics and local measures like hot fomentation.
Image 6 – Bilateral Neck Of Femur Fracture Following Trauma
Bilateral fracture neck of femur are quiet rare and are mostly seen in females with osteomalacia.
Following xray is of 47 years old female who had fracture of both the femoral neck femur following trauma.
The patient was advised osteosynthesis for both the fractues. She wanted another opinion and did not follow.
Image 7 – Anterior Dislocation of Hip Treated By Closed Reduction
Sixteen years male got injured due to fall of building and had anterior dislocation of right hip. Following photograph was taken before reduction maneuver was done.
It shows flexed and externally rotated right hip.
Here is the xray of the patient showing anterior dislocation.
Xray after reduction
The hip was stable after reduction and patient recovered well eventually.
Image 8 -Xrays Of Operated United Fracture Neck Of Femur
Following xrays are of 47 years old adult male who was operated for fracture neck of femur 4 months prior to these xrays with cancellous cannulated screws
The xrays show a well formed union of the fracture.
Here is the AP view
Here is the lateral view.
To be technically precise, this view is more of oblique than lateral
The patient demonstrated almost full range of movements.
Image 9 – Severely Comminuted Fracture Upper End Femur- Xray
Following xray is of 39 years old adult male who was injured in motor vehicle accident.
The upper end of femur is fractured and severely comminuted.
Image 10 – Slipped Upper Femoral Epiphysis
y of 13 years old male showing slipped upper femoral epiphysis.
No other associated information is available with the image file.
Image 11 – Xray of Fracture of Neck of Femur In nine Year Old Child
Xray of Fracture of neck of femur in a nine year old child
The fracture is not displaced. Even undisplaced, this kind of fracture requires surgical fixation.
Image 12 – Xray Pelvis Showing Fracture of Acetabulum
Following is a post reduction film of dislocated hip with fracture of posterior wall of acetabulum.
The patient was 40 years old male who fell from height .
Image 13 – Central Fracture Dislocation Hip With Schanz Pins Put In Femoral Head For Traction
Xray of pelvis showing central fracture dislocation on right side and two Schanz pins for purpose of traction.
The patient was treated by conservative treatment in form of skeletal traction.
Iamge 14 – Xray of Bilateral Fracture Neck of Femur
Image 15 – Xray of Hip Showing Fracture of Neck of Femur
Forty eight years old male fell from roof and suffered hip injury.
Xray revealed fracture of neck of femur
The patient was advised closed reduction and internal fixation with cannulated cancellous screws.
Image 16 – Xray Pelvis Showing Fracture of Superior and Inferior Pubic Rami
Sixteen years old girl had a motor vehicle accident and suffered fractures of superiror and inferior pubic rami.
A fracture of the area where both rami meet is also seen.
Image 17 – Ununited Subtrochanteric Fracture With in situ DHS and Broken Screws
Xray of operated fracture femur in subtrochanteric region after one year of surgery. Interfragmentary screw and DHS have been used to fix the fracture.
The fracture is still not united and screw of DHS plate have been broken.
Image 18 – Xray of Hip Showing Reduced Hip Dislocation with Acetabular Fracture Fragment
Fifty years old male fell from height in the night and was brought to emergency of the hospital. Clinical examination suggested a posterior hip dislocation.
The xray revealed an acetabular fracture in addition to dislocation. The dislocation was reduced and CT was done [pic not available].
The patient was advised fixation of the acetabular fracture but patient refused.
Following is the xray after two months of injury.
The patient walks with a painful limp and abduction is limited.
Image 19 – Xray of Fracture of Neck of Femur In 85 Years Old Female
85 years old lady fell in the bathroom and was brought to OPD after 6 days of injury. She complained of pain and inability to bear weight on the right limb. An xray of the injured hip revealed fracture of neck of femur
The lady was advised hemiarthroplasty for the treatment but she chose not to get operated.
Image 20 – Xrays of Subtrochanteric Fracture Treated By Dynamic Hip Screw Fixation and Dimon Hughston Osteotomy
The following x-rays belong 75 year old woman, hypertensive & diabetic, who got injured due to a fall at home.
She was kept on native bandages and was brought to our clinic two months after the injury.
The x-ray revealed a subtrochanteric fracture of the femur.
Following x-ray was done in traction and rotation to visualize complete profile of the fracture.
After optimizing her medical condition, she was operated under epidural anaesthesia.
The fragments were found to be fixed in the displaced position due to soft tissue contractures owing to the delay in presentation.
As anatomical reduction could not be achieved, Dimon-Hughston principle was implemented.
Immediate postoperative x-rays are shown below. Here is the AP view
And here is lateral view
She had stable reduction (although non anatomical) achieved on table, after pegging the medial calcar spike into the shaft and then fixed using a 70mm lag screw coupled to a 135 degree locking barrel plate.
She was mobilized from day 2 post op. allowing weight bearing as tolerated, progressing to full weight bearing in a week days, using a zimmer frame [walker]
The fracture united in about 4 months time with an inch shortening.
So, if anatomical reduction can not be achieved -either due to comminution or delayed presentation, it is worth trying non anatomical pegging & fixation.
Image 21 – Subtrochanteric Fracture Treated By Proximal Femoral Nail – Preoperative and Intraoperative Xrays
Painter by profession, a 24 years old young male fell from height while painting the building and had subtrochanteric fracture of femur. Here is the xray after the injury.
An image from C-arm image intensifier is shown below.
The patient has been put on mobilization exercises and is in follow up.
Image 22 – Pathlogical Fracture of Proximal Femur With Lytic Lesion
Pathological fracture is a fracture that occurs in bone weakened by preexisting disease. This xray is of 12 years old female child which shows fracture in the proximal femur and a concomitant lytic lesion.
The lesion came out to be aneurysmal bone cyst later and was treated by curettage and evacuation followed by filling the defect with bone grafting .
The white arrow marks the lytic lesion.
Image 23 – United Fracture Neck of Femur In a Child with Cannulated Screws in Situ
Image 24 – Xrays of Failed Smith Petersen Nail in Fracture of Neck of Femur
Smith Peterson nail in fracture of neck of femur. This xray was taken immediately after the surgery.
However, with time the varus defrmity developed and nail pierced the head.
The above xray is after 9 months of the surgery and there is marked ostroporosis as well.
Image 25 – Subtrochanteric Fracture Treated By Proximal Femoral Nail
Following is an xray of subtrochanteric fracture of femur in a 39 years old male who got injured in motor vehicle accident.
he fracture was treated by using proximal femoral nail. A closed reduction and internal fixation was done.
The xray was taken in immediate postoperative period.
Image 26 – Fracture Neck of Femur in 70 Years Old Male
Following xray shows fracture of neck of left femur in 70 years old male who fell while he had gone for a walk.
The patient was advised bipolar hemiarthroplasty for the treatment.
Image 27 – Subtrochanteric Fracture with Ipsilateral Hip Dislocation
X-ray of subtrochanteric fracture with dislocation of hip is shown.
The fracture is oblique and comminuted.
Image 27 – Central fracture dislocation of hip
This is a fracture of acetabular region atop the head of femur which leads to proximal movement of the hip. It requires mostly internal fixation.
Image 28 – Fracture of Neck of Femur in a Child
The child was treated by screw fixation.
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