Hip Dislocation, Traumatic
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Etiology and Pathophysiology
- Protective factors: depth of acetabulum, surrounding labrum, thick joint capsule, and strong muscular support
- Caused by high-velocity mechanisms—most commonly “dashboard” leg injuries in motor vehicle collisions and falls from a height (1,3)[A]
- Posterior dislocations represent 85–90% of traumatic dislocations; anterior dislocations 10–15% (1,2)[B]
- Posterior dislocations occur when the knee is flexed and the hip is adducted and flexed.
- Anterior dislocations occur when the hip is abducted and externally rotated.
- Anterior dislocations can occur in sporting activities such as American football, rugby, skiing, bicycling, basketball, and gymnastics (4)[C].
- The force required to cause a dislocation increases with age. Minor trauma may produce dislocation before age 10 years. Higher energy trauma is typical after age 12 years (5)[C].
- The femoral epiphysis may be injured during dislocation, complicating long-term prognosis. Surgical reduction is necessary (5)[C].
- Immobilization postreduction in a spica cast or bed rest for 3 to 4 weeks is recommended for children age <10 years (5)[C].
- Up to 25% of pediatric hip dislocations have a labral injury or loose osteochondral fragment (5)[C].