Hip dislocation are a violation of the relative position of the femoral head and the acetabulum. It is accompanied by sharp pain, swelling, deformation of the hip joint, shortening of the limb on the affected side. Movements in the joint become impossible. The diagnosis is established according to the examination data and the results of radiography. If necessary, an additional CT or MRI of the joint is prescribed. Treatment of hip dislocation is reduced to their reduction and subsequent fixation for up to 1 month. In the recovery phase, physical therapy, physiotherapy and massage are actively used.
ICD 10
S73.0 Hip dislocation
Causes
As a rule, disease occurs as a result of a significant high-speed application of traumatic force. The damage is caused by road accidents, falls from heights, natural disasters and industrial accidents.
Pathogenesis
Pathology occur as a result of indirect injury. In this case, the femur acts as a lever acting on the hip joint area. As a result of intense exposure, the femoral head ruptures the joint capsule, damages the ligaments and exits the articular cavity. The cause of a posterior dislocation of the hip is usually a road injury. The mechanism of traumatic impact is a sharp rotation or bending of the turned inside, brought and bent leg. Anterior hip dislocation occurs more often when falling from a height to an outwardly turned, retracted and bent leg.
Classification
In traumatology and orthopedics, anterior and posterior hip dislocation are distinguished. Anterior dislocations, in turn, are subdivided into anteropteric (supraplonic) and anteropteric (locking), and posterior – into posteropteric (iliac) and posteropteric (sciatic).
Posterior hip dislocation occur about 5 times more often than anterior ones.
- a – posterior dislocation
- b – posterior dislocation
- c – anterior dislocation
- d – anterior dislocation
Hip dislocation symptoms
The patient complains of sharp pain in the hip joint. All types of hip dislocation are characterized by a forced position of the limb, deformation of the hip joint, more or less pronounced shortening of the limb on the side of the injury. Passive movements in the hip joint are painful, sharply limited, accompanied by springy resistance. Active movements are impossible.
The forced position of the limb is determined by the location of the femoral head in relation to the acetabulum. With posterior dislocations, the patient’s leg is brought, bent and turned inward with the knee. With posterior hip dislocation, the deformation of the hip joint is more pronounced than with posterior. With anterior dislocation, the patient’s limb is turned outward, pulled aside, bent at the hip and knee joints. Anterior dislocation is accompanied by a more pronounced flexion and withdrawal of the leg.
With posterior form, the femoral head is palpated under the muscles of the buttocks, with posterior form – next to the sciatic bone. The anteroposterior dislocation is characterized by flattening of the gluteal region. The femoral head is palpated in the area of the inguinal fold, outward from the femoral artery. Anterior dislocation is also accompanied by flattening of the buttock area. The head is probed inside from the femoral artery.
Hip dislocation can be accompanied by the separation of the acetabulum edge and damage to the cartilage of the femoral head. With posterior dislocations of the hip, a contusion of the sciatic nerve is often observed. With anterior form, compression of the femoral vessels is possible, with anterior – damage to the locking nerve.
Stale and long-standing disease are accompanied by less pronounced clinical symptoms. Pain in the joint area decreases over time. Shortening and deformity of the limb are compensated by the tilt of the pelvis and a sharp increase in lordosis (lumbar bend) of the spine.
Diagnostics
Diagnosis of hip dislocation, as a rule, does not cause difficulties for a traumatologist. To clarify the position of the femoral head and exclude possible bone damage, an X-ray examination in two projections or an MRI of the hip joint is performed.
Hip dislocation treatment
Treatment consists in urgent reduction and short-term fixation, followed by mandatory functional therapy (physiotherapy and therapeutic gymnastics). Traumatic dislocation of the hip is accompanied by a reflex contraction of the powerful muscles of the thigh and the gluteal region. For successful reduction, it is necessary to effectively relax these muscles, so the reduction of hip dislocation is performed in a hospital under general anesthesia with the use of muscle relaxants.
When correcting fresh anterior, posterior and posterior dislocations of the hip, the Janelidze method is used, when correcting old and fresh anterior dislocations, the Kocher method is used. With anterior hip dislocation, the Janelidze method is not used, since there is a danger of breaking the femoral neck during the reduction process. After reduction, skeletal traction is applied for a period of 3-4 weeks. Then the patient is recommended to walk on crutches for 10 weeks, physiotherapy and therapeutic gymnastics are prescribed.
Damage to the cartilage of the femoral head during hip dislocation often leads to the development of deforming arthrosis of the hip joint (coxarthrosis) in the long term. In such cases, with the pronounced development of disorders in the joint, hip replacement may be required – its removal and installation of a prosthesis.
Literature
- Adolescent Hip Dislocation Combined With Proximal Femoral Physeal Fractures and Epiphysiolysis. Kennon JC, Bohsali KI, Ogden JA, Ogden J 3rd, Ganey TM. J Pediatr Orthop. 2016 Apr-May;36(3):253-61. link
- Traumatic hip dislocation at a regional trauma centre in Nigeria. Onyemaechi NO, Eyichukwu GO.Niger J Med. 2011 Jan-Mar;20(1):124-30. link
- Anterior dislocation of a total hip replacement. Radiographic and CT-scan assessment. Behavior following conservative management. Di Schino M, Baudart F, Zilber S, Poignard A, Allain J. Orthop Traumatol Surg Res. 2009 Dec;95(8):573-8. link
- A Detailed Review of Hip Reduction Maneuvers: A Focus on Physician Safety and Introduction of the Waddell Technique. Waddell BS, Mohamed S, Glomset JT, Meyer MS. Orthop Rev (Pavia). 2016 Mar 21;8(1):6253. link