What is it?
The total hip dislocation is a painful complication in which the femoral ball component comes out (dislocates) of its place in the cup component and moves outside the total hip.
Hip dislocations are relatively uncommon during athletic events.1 Injuries to small joints (eg, finger, wrist, ankle, knee) are much more common. However, serious morbidity can be associated with hip dislocations, making careful and expedient diagnosis and treatment important for the sports medicine physician.
Note that the centre of the dislocated right ball component lies above the centre of the left normal hip joint. The upper position of the dislocated ball is due to forceful and painful contracture of thigh muscles that pushed the dislocated ball into this position. At examination the doctor found the right leg stretched and rotated outwards and shorter.
Types of dislocations:
- Anterior dislocation
- Central acetabular fracture dislocations
- Posterior hip dislocations
Is result of simultaneous hip abduction, external rotation, & flexion;
Sharp anterolateral margin of obturator foramen may indent anterosuperior aspect of the femoral head, resulting in the so called indentation frx;
Assoc injuries include frxs of acetabulum, greater trochanter or femoral head;
Why is it a problem?
- Total hip dislocation is a very painful condition
- Total hip dislocation distress the patients who are scared to continue their every day activities and don’t dare to continue with gymnastics for fear of a dislocation
- For reposition of the dislocated ball component the patient must have anesthesia combined with muscle relaxing medicines; the anesthesia has inherent risks for the patient.
- Repeated dislocations need revision operation ; these operation imply often severe surgical trauma for the often old and frail patients.
- Hip dislocations usually present with the athlete complaining of severe pain around the hip and proximal thigh.
- Anterior hip dislocations may present in 2 different ways.
- Superiorly displaced dislocations present with the affected hip extended and externally rotated.
- The inferior type of anterior dislocations presents with the affected hip flexed, abducted, and externally rotated.
- However, the affected limb of a posterior hip dislocation most commonly appears shortened, internally rotated, and adducted.
- In those patients whose mechanism of injury suggests a posterior hip dislocation but who have no evidence of a dislocation on examination, a traumatic posterior hip subluxation should be considered. This injury carries many of the risks of a true dislocation and may be overlooked
- Assessing the neurovascular status of the injured leg is extremely important. Nerve injury, particularly neurapraxia, is not uncommon. The sciatic nerve and the common peroneal division of the sciatic nerve are most often injured in posterior dislocations. Simple observation and palpation for bony deformity, skin color, and temperature provides clues to the vascular status of the leg. Test reflexes, strength, and sensation in the affected leg, and palpate for femoral and distal pulses.
Signs of total hip dislocation:
Usually the patient feels very painful "popping" in the total hip joint. Often this popping occurs after a sudden vigorous movement or accident.
The patient is keeping the whole leg stiff and firmly pushed to the midline and the other leg (if the ball is dislocated backwards), or rotated outwards and pushed from midline (if the ball is rotated frontwards). He/she resists every attempt to move the leg because every such attempt is very painful.
If the patient has had many dislocations in the past, the pain may be only moderate, but the ability to move the leg is still severely restricted.
- Heterotopic Ossification
- AVN after Hip Dislocation
- Sciatic Nerve Injury:
- approx 10% w/ dislocation but may be as high as 35% in posterior acetabular fracture;
- iatrogenic injury may be the result of laceration, penetration by drill bits, excessive traction by retractors, or prolonged extension of the ipsilateral knee;
- it appears that injuries of peroneal division of sciatic nerve have a worse prognosis than injuries of the tibial division;
- Coxa Magna
- may occur in upto 50% of children who sustain hip dislocation
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