Hip dislocation: causes, symptoms, diagnosis, treatment

ICD-10 code

S73.0. Dislocation of the hip.

Epidemiology of hip dislocation

Traumatic dislocation of the hip is from 3 to 7% of the total number of dislocations. In the first place in the frequency is iliac hip dislocation (85%), then sciatic, blocking, in the last place - the abdominal dislocation of the hip.

[1], [2], [3], [4], [5], [6], [7], [8]

What causes a hip dislocation?

More often dislocation of the femur occurs in men of working age as a result of the indirect mechanism of injury, when the violence 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 hip joint functions, which occurred after the trauma.

Anamnesis

A characteristic mechanism of injury in history.

Examination and physical examination

Active movements are impossible. When trying to perform passive, a symptom of springing resistance occurs . The lower extremity is deformed and takes a forced position, characteristic for each type of dislocation.

In iliac dislocation, the hip is moderately bent, brought and rotated internally. Mark the decrease in the functional length of the limb. A large spit is defined above the Roser-Neelaton line. In the gluteal region on the side of the dislocation, the head of the femur is palpated.

With sciatic dislocation, the thigh is significantly bent, somewhat rotated inward and reduced. The head of the femur is probed downward and posteriorly from the acetabulum.

When the hip is dislocated, the limb is unbent, somewhat withdrawn and rotated outwards. At a palpation define a head of a femur under an inguinal sheaf.

When the hamstring is dislocated, the lower limb is sharply bent in the hip and knee joints, withdrawn and rotated outwards. A large spit is not probed, and in the region of the occlusal aperture protrusion is determined.

In the case of anterior dislocations of the hip, the cyanotic color of the limb is usually noted due to the compression of the vessels by a 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:

• posterior upper - iliac hip dislocation;
• posterior - sciatic dislocation;
• anteroposterior dislocation;
• Upper nerve - blocking hip dislocation.

[9], [10], [11], [12]

Diagnosis of hip dislocation

The final diagnosis of "hip dislocation" is post-radiographed.

[13], [14], [15]

Treatment of hip dislocation

Indications for hospitalization

Dislocation of the hip - an emergency injury, you must immediately remove it. The victim should be taken to the hospital for assistance.

Conservative treatment of hip dislocation

Anesthesia is common, only when it is impossible to do it is resorted to local anesthesia. In the joint injected with 30-40 ml of 1% solution of novocaine.

The two methods of eliminating the hip dislocation and their modification have become most widespread. These are the methods of Kocher and Janelidze.

The method of Kocher is preferable for eliminating anterior dislocations of the femur or stale dislocations, regardless of the species.

The patient is laid on the floor on his back, the assistant fixes the pelvis of the victim with both hands. The surgeon flexes the patient's limb at right angles to the knee and hip joints and produces a slowly increasing traction along the hip axis for 15-20 minutes. This manipulation can be facilitated by the method proposed by N.I. Kefer: the surgeon kneels, and the other leg bends at a right angle and leads to the popliteal fossa of the patient. Having seized the shin with his hand in the supraglobar region, the doctor presses on her back and, as a lever, produces a hip extension. After traction, the hip is driven and then rotated outward and its retraction. There is a repositioning.

For each type of dislocation, the segments of the segmentation must be inverted to the mechanism of its appearance.

The disadvantages of placing the patient on the floor using the Koher-Kofer method can be avoided using the following technique. The surgeon becomes next to the patient lying on the dressing table at the level of the damaged hip joint with his back to the head end. A dislocated limb popliteal fossa lays on its own shoulder and, seizing the distal part of the shin, uses it as a lever. The further technique is according to Kocher.

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

After hip adjustment, the limb is immobilized with a trough-shaped laryngeal from the angle of the scapula to the ends of the fingers for 4 weeks. Gypsum immobilization can be replaced by cuff disciplinary traction with a load of 1-2 kg for the same period. UHF, electrophoresis of procaine on the hip joint are shown.

After eliminating immobilization, walking on crutches for 8-10 weeks is recommended. The load on the damaged limb due to the danger of development of aseptic necrosis of the head of the femur is allowed not earlier than 3 months from the moment of injury.

Surgical treatment of hip dislocation

When the conservative method is ineffective and chronic dislocations, surgical correction of the dislocation is applied.

Estimated period of incapacity for work

The ability to work is restored in 14-15 weeks.

[16], [17], [18]