Simple fracture, anterior or posterior wall column II - Transverse fracture III - T - Type fracture involving two columns IV - Both columns fractures, floating acetabulum Diagnosis Ideal x-ray visualization of an elementary fracture will depend on the fracture type: Posterior wall fracture: Iliac oblique and obturator oblique views Posterior column fracture: Iliac oblique and obturator oblique views Anterior wall fracture: Iliac oblique view Anterior column fracture: Obturator oblique view In all cases, CT scan can assist in identifying impacted bone pieces, which may be found within the joint, and MRI may be done to identify the extent of potential injury to the sciatic nerve. Treatment If the femur head is dislocated, it should be reduced as soon as possible, to prevent damage to its blood supply. This is preferably done under anaesthesia, following which, leg is kept pulled by applying traction to prevent joint from dislocating. The final management depends on the size of the fragment(s), stability and congruence of the joint. In some cases traction for six to eight weeks may be the only treatment required; however, surgical fixation using screw(s) and plate(s) may be required if the injury is more complex. The latter treatment will be called for if bone fragments do not fall into place, or if they are found in the joint, or if the joint itself is unstable. Post-surgery Depending on the stability achieved via initial treatment, the patient may be allowed to stand and walk with help of support within about six to eight weeks. Full function may return in about three months. Principles of management At the site of injury: After stabilizing an injured person and resuscitation, quick examination is done to check injury to vital organs. If one suspects injury to the hip, it is imperative to immobilise the limb using some kind of support to prevent movements of the injured limb to prevent further damage A trained paramedic may be able to diagnose hip dislocation by noticing the position of the injured limb. It is essential to document status of nerves and vessels before starting any treatment to protect oneself from litigation On arrival at the hospital, trained trauma surgeon will assess the patient and prescribe necessary tests including x-rays as described earlier. Non-surgical management consists of reducing the dislocated joint by maneuver under anaesthesia and applying traction to the limb to maintain position of joint and fractured bones.