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Hip Dislocation
From WikiSM
Contents
Other Names
- Hip Fracture-Dislocation
- Hip Subluxation
- Posterior Hip Dislocation
Background
- This page refers to dislocations of the Hip Joint
History
Epidemiology
Pathophysiology
- General
Mechanism
- General
- Most common mechanism is during a motor vehicle accident when an individual's flexed knee strikes the dashboard
- Traumatic hip dislocations are rare in sports
- Athletic-related hip dislocations are often trauma-related due to a collision
- Common sports with hip dislocations include snowboarding, skiing, rugby, basketball and American football [3]
- Posterior hip dislocation
- may occur one of two ways
- With a flexed, adducted hip when there is a forward fall on a knee
- Blow from posterior to anterior while the athlete is on his or her hands and knees [3]
- Anterior hip dislocation
- Flexed hip is forced into excessive abduction and external rotation (ie, splits-related injury) [4]
Risk Factors
- Contact Sports
- History of Total Hip Arthroplasty
Differential Diagnosis
- Fractures And Dislocations
- Arthropathies
- Muscle and Tendon Injuries
- Bursopathies
- Ligament Injuries
- Neuropathies
- Other
- Pediatric Pathology
- Transient Synovitis of the Hip
- Developmental Dysplasia of the Hip (DDH)
- Legg-Calve-Perthes Disease
- Slipped Capital Femoral Epiphysis (SCFE)
- Avulsion Fractures of the Ilium (Iliac Crest, ASIS, AIIS)
- Ischial Tuberostiy Avulsion Fracture
- Avulsion Fractures of the Trochanters (Greater, Lesser)
- Apophysitis of the Ilium (Iliac Crest, ASIS, AIIS)
Clinical Features
- History
- Inquire about the mechanism of injury: trauma to the area during contact sports, high-speed accident in racing sports, or awkward jumping, landing or twisting of
- Severe hip and upper leg pain
- Inability to bear weight
- Limb deformity
- Possible paresthesias
- Physical Exam: Physical Exam Hip
- Posterior hip dislocation
- Hip is shortened, adducted, flexed, and internally (medially) rotated
- Sciatic and common peroneal nerve are frequently injured
- Anterior hip dislocation
- hip is flexed, abducted, and externally (laterally) rotated.[8]
- Posterior hip dislocation
Evaluation
Radiographs
- Should be done before closed reduction and after apparent successful closed reduction[4]
- A/P and lateral films of the hip and A/P pelvic radiographs are recommended
- A/P view of the pelvis
- Posteriorly dislocated femoral head will appear smaller than the uninjured side
- Anteriorly dislocated femoral head will appear larger than the normal side
- May reveal concurrent femoral neck fracture
- X-rays should be obtained at 2 weeks, 6 week, 3 months and 6 months after injury to ensure no avascular necrosis or arthritis development [4]
CT
- Useful if there is a need to remove interposed tissue or associated fracture(s)
MRI
- Obtained after successful closed reduction to ensure there is no damage to soft tissue
- May provide baseline comparison to follow the development of avascular necrosis
- Recommended with persistent or new-onset pain in the setting of normal X-rays [4]
Classification
- Hip dislocation may be initially classified as anterior or posterior depending on the direction of femoral head movement
- Posterior dislocation may be further characterized using the following schemes
- Thompson and Epstein Classification (based on radiographic findings) [9]
- Type 1 – With or without minor fracture
- Type 2 – Large, single fracture of posterior acetabular rim
- Type 3 – Comminution of rim of acetabulum, with or without major fragments
- Type 4 – Presence of a fracture of the acetabular floor
- Type 5 – Presence of a fracture of the femoral head
- Steward and Milford Classification (based on hip stability) [10]
- Type 1 – No fracture or insignificant fracture
- Type 2 – Associated with a single or comminuted posterior wall fragment, but the hip remains stable through a functional range of motion
- Type 3 – Associated with an unstable hip joint due to loss of structural support
- Type 4 – Associated with femoral head fracture
- Thompson and Epstein Classification (based on radiographic findings) [9]
Management
- Operative and non-operative techniques should be done to reduce the dislocation as long as possible with a goal of less than six hours [11]
Nonoperative
- First line if possible
- See: Hip Reduction
- Other Treatment
- NSAIDs
- Ice
- Rest
- Physical therapy [8]
- Focused on strengthening the quadriceps, hamstrings, hip flexors, and hip extensors
- Maintenance and improvement of hip range of motion
Operative
- Open reduction with internal fixation is the preferred method if closed reduction fails
- Indications [11]
- Failure of closed reduction
- Presence of bony fragments or soft tissue in the joint space
- Hips that have been dislocated for a long period of time
- Joint instability
- Redislocation
- Technique [11]
- Posterior dislocations
- Treated with the Kocher-Langenbeck Approach
- Posterior structures are accessed by demarcation of the posterior superior iliac spine, greater trochanter, and femoral shaft
- Treated with the Kocher-Langenbeck Approach
- Anterior dislocations
- Smith-Petersen or Watson-Jones approach
- Anterior structures are accessed by demarcation of the anterior superior iliac spine, greater trochanter, and femoral shaft
- Smith-Petersen or Watson-Jones approach
- Arthroscopy can be used to remove bone fragments and repair labral tears
- Posterior dislocations
Rehab and Return to Play
Rehabilitation
- Functional weight-bearing exercises (ie, bodyweight squats) may begin at around 4 weeks
- Jogging or running may begin at 6-8 weeks
Return to Play
- Most athletes may return to full activity in 3-4 months
Complications and Prognosis
Prognosis
Complications
- General
- 71% of traumatic hip dislocations have other associated injuries[12]
- Avascular necrosis (<6% in Type I and II dislocations, ~50% in type III and IV) [13]
- Osteoarthritis (25%) [13]
- Need for Total Hip Arthroplasty
- Myositis ossificans
- Labral tear
- Sciatic Nerve Injury (10% in adults, 5% in children) [14]
See Also
- Internal
- External
- https://www.sportsmedreview.com/blog/management-of-posterior-hip-dislocations/
- Sports Medicine Review Hip Pain: https://www.sportsmedreview.com/by-joint/hip/
References
- ↑ Dawson-Amoah K, Raszewski J, Duplantier N, Waddell BS. Dislocation of the Hip: A Review of Types, Causes, and Treatment. Ochsner J. 2018;18(3):242–252. doi:10.31486/toj.17.0079
- ↑ Sahin V, Karakaş ES, Aksu S, Atlihan D, Turk CY, Halici M J Trauma. 2003 Mar; 54(3):520-9.
- ↑ 3.0 3.1 Giza E, Mithöfer K, Matthews H, Vrahas M. Hip fracture-dislocation in football: a report of two cases and review of the literature. Br J Sports Med. 2004;38(4):E17. doi:10.1136/bjsm.2003.005736
- ↑ 4.0 4.1 4.2 4.3 Pallia CS, Scott RE, Chao DJ. Traumatic hip dislocation in athletes. Curr Sports Med Rep. 2002 Dec;1(6):338-45.
- ↑ Woo RY, Morrey BF J Bone Joint Surg Am. 1982 Dec; 64(9):1295-306.
- ↑ Dargel J, Oppermann J, Brüggemann GP, Eysel P Dtsch Arztebl Int. 2014 Dec 22; 111(51-52):884-90.
- ↑ Bozic K, Kurtz S, Lau E, et al. The epidemiology of revision total hip arthroplasty in the United StatesJ Bone Joint Surg. [Am] 2009;91-A:128–133.
- ↑ 8.0 8.1 Yates, C., Bandy, W. D., & Blasier, R. D. (2008). Traumatic dislocation of the hip in a high school football player. Physical therapy, 88(6), 780–788. doi:10.2522/ptj.20070298
- ↑ Thompson VP, Epstein HC. Traumatic dislocation of the hip: a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg Am. 1951;33:746–778
- ↑ Stewart MJ, Milford LW. Fracture-dislocation of the hip: an end-result study. J Bone Joint Surg Am. 1954;36:315–342.
- ↑ 11.0 11.1 11.2 Dawson-Amoah K, Raszewski J, Duplantier N, Waddell BS. Dislocation of the Hip: A Review of Types, Causes, and Treatment. Ochsner J. 2018;18(3):242–252. doi:10.31486/toj.17.0079
- ↑ Sahin, Vedat, et al. "Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study." Journal of Trauma and Acute Care Surgery 54.3 (2003): 520-529.
- ↑ 13.0 13.1 Dwyer AJ, John B, Singh SA, Mam MK. Complications after posterior dislocation of the hip. Int Orthop. 2006;30(4):224–227. doi:10.1007/s00264-005-0056-9
- ↑ Cornwall R, Radomisli TE. Nerve injury in traumatic dislocation of the hip. Clin Orthop Relat Res. 2000 Aug;(377):84-91.
Created by:
John Kiel on 5 July 2019 08:31:08
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Last edited:
5 October 2022 13:04:41
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