Hip dislocation: causes, symptoms, diagnosis, treatment

ICD-10 code

S73.0. Dislocation of hip.

Epidemiology of hip dislocation

Traumatic hip dislocations account for 3 to 7% of all dislocations. The most common is iliac hip dislocation (85%), followed by sciatic, obturator, and suprapubic hip dislocation.

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What causes a hip dislocation?

Most often, hip dislocation occurs in men of working age as a result of an indirect mechanism of injury, when the force applied to the femur exceeds the functional capabilities of the hip joint.

Symptoms of hip dislocation

The victim complains of severe pain and loss of function in the hip joint that followed the injury.

Anamnesis

Characteristic mechanism of injury in the anamnesis.

Inspection and physical examination

Active movements are impossible. When attempting to perform passive movements, a symptom of spring resistance occurs. The lower limb is deformed and takes a forced position, characteristic of each type of dislocation.

In iliac dislocation, the hip is moderately flexed, adducted, and rotated inward. A decrease in the functional length of the limb is noted. The greater trochanter is determined above the Roser-Nelaton line. The head of the femur is palpated in the gluteal region on the side of the dislocation.

In sciatic dislocation, the hip is significantly flexed, slightly rotated inward, and adducted. The head of the femur is palpated downward and posterior to the acetabulum.

In case of suprapubic dislocation of the hip, the limb is extended, slightly abducted and rotated outward. During palpation, the head of the femur is determined under the inguinal ligament.

In case of obturator dislocation of the hip, the lower limb is sharply bent at the hip and knee joints, abducted and rotated outward. The greater trochanter is not palpated, and a protrusion is determined in the area of the obturator foramen.

In anterior hip dislocations, a bluish discoloration of the limb is usually noted due to compression of the vessels by the dislocated segment.

Classification of hip dislocation

Depending on the direction of the force, the femoral head may dislocate posteriorly or anteriorly from the acetabulum. There are four main types of hip dislocations:

• posterosuperior - iliac dislocation of the hip;
• posteroinferior - sciatic dislocation;
• anterosuperior - suprapubic dislocation;
• anteroinferior - obturator dislocation of the hip.

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Diagnosis of hip dislocation

The final diagnosis of hip dislocation is made after an X-ray.

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Treatment of hip dislocation

Indications for hospitalization

Hip dislocation is an emergency injury that requires immediate treatment. The victim should be taken to a hospital for assistance.

Conservative treatment of hip dislocation

General anesthesia, only if it is impossible to perform local anesthesia is used. 30-40 ml of 1% novocaine solution is injected into the joint.

The two most widely used methods for eliminating hip dislocation and their modifications are the Kocher and Dzhanelidze methods.

The Kocher method is preferred for correcting anterior hip dislocations or old dislocations, regardless of the type.

The patient is placed on the floor on his back, the assistant fixes the pelvis of the victim with both hands. The surgeon bends the patient's limb at a right angle at the knee and hip joints and slowly increases traction along the axis of the thigh for 15-20 minutes. This manipulation can be facilitated by the technique proposed by N.I. Kefer: the surgeon kneels and bends the other leg at a right angle and brings it to the popliteal fossa of the patient. Grasping the shin with his hand in the supramalleolar region, the doctor presses it backwards and, like a lever, tractions the thigh. After traction, the thigh is brought, and then rotated outward and abducted. Reduction occurs.

For each type of dislocation, the stages of segment reduction should be the reverse of the mechanism of its occurrence.

The inconvenience of laying the patient on the floor when using the Kocher-Kefer method can be avoided by using the following technique. The surgeon stands next to the patient lying on the dressing table at the level of the damaged hip joint with his back to the head end. He places the dislocated limb with the popliteal fossa on his shoulder and, having grasped the distal part of the shin, uses it as a lever. The further technique is according to Kocher.

Yu. Yu. Dzhanelidze's method. The patient is placed on the table on his stomach so that the injured limb hangs off the table, and left in this position for 15-20 minutes. Then the injured leg is bent at the hip and knee joints at an angle of 90° and slightly abducted. The surgeon grasps the distal part of the shin and presses on the patient's shin with his knee, producing traction along the axis of the thigh, and then several smooth rotational movements. The thigh is reduced with a characteristic click. Confirmation of the achieved goal is the absence of the symptom of springy resistance and control radiography.

After hip reduction, the limb is immobilized with a trough-shaped splint from the angle of the scapula to the tips of the fingers for 4 weeks. Plaster immobilization can be replaced with cuff disciplinary traction with a load of 1-2 kg for the same period. UHF, electrophoresis of procaine on the hip joint are indicated.

After the immobilization is eliminated, walking on crutches is recommended for 8-10 weeks. Loading the injured limb due to the risk of developing aseptic necrosis of the femoral head is allowed no earlier than 3 months after the injury.

Surgical treatment of hip dislocation

If the conservative method is ineffective and the dislocations are chronic, surgical reduction of the dislocation is used.

Approximate period of incapacity

Working capacity is restored after 14-15 weeks.

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