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Hip Dislocation, Traumatic

Hip Dislocation, Traumatic is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Displacement of the femoral head from the acetabulum
  • ~5% of all traumatic joint dislocations (1)[A]
  • True orthopedic emergency

Epidemiology

  • Highest rates in males ages 16 to 40 years; most commonly from motor vehicle collisions (2)[B]
  • 70–100% of posterior hip dislocations occur due to motor vehicle collisions (2)[B]; higher incidence of right hip dislocations in motor vehicle collisions (2)[B]

Etiology and Pathophysiology

  • Depth of acetabulum, surrounding labrum, thick joint capsule, and strong muscular support protect against hip dislocation.
  • Caused by high-velocity mechanisms—“dashboard” leg injuries in motor vehicle collisions and falls from a height are most common (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].
Pediatric Considerations
  • 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].
  • 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].

Commonly Associated Conditions

  • Acetabular fractures
  • 25% have ipsilateral knee injuries (2)[B].
  • Sciatic nerve damage (10–14% of posterior dislocations) (1,2)[B]
  • Exclude closed head injuries, thoracic injuries, and abdominal injuries in high-velocity injuries.

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Citation

Stephens, Mark B., et al., editors. "Hip Dislocation, Traumatic." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816840/all/Hip_Dislocation__Traumatic.
Hip Dislocation, Traumatic. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816840/all/Hip_Dislocation__Traumatic. Accessed April 19, 2019.
Hip Dislocation, Traumatic. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816840/all/Hip_Dislocation__Traumatic
Hip Dislocation, Traumatic [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 19]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816840/all/Hip_Dislocation__Traumatic.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hip Dislocation, Traumatic ID - 816840 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816840/all/Hip_Dislocation__Traumatic PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -