MANUAL MINORS
Anterior hip dislocation is less common than posterior dislocation and occurs when the femoral head shifts forward out of the acetabulum. This type of dislocation is typically associated with high-energy trauma, where the hip is in extension, abduction, and external rotation at the time of impact. It is a serious injury that can compromise joint stability, as well as the blood vessels and nerves surrounding the hip.
Diagnosis
The patient presents with severe pain in the groin area, and the affected leg is in abduction and external rotation. In some cases, the limb may appear lengthened. A pelvic X-ray confirms the diagnosis by showing the femoral head displaced anteriorly in relation to the acetabulum. Computed tomography (CT) is useful for assessing associated fractures of the acetabulum or femoral head.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Posterior hip dislocation | The leg is in internal rotation and adduction, with the femoral head displaced backwards |
Femoral neck fracture | Hip pain without anterior displacement of the femoral head |
Intertrochanteric fracture | No anterior displacement, but possible shortening and external rotation of the leg |
Acetabular labral tear | Pain during movement, no deformity or visible displacement on imaging |
Avascular necrosis of the femoral head | Chronic pain without acute trauma, visible on MRI in early stages |
Emergency Management
Initial management includes stabilising the patient, administering analgesics, and sedation for urgent reduction. Closed reduction should be performed as soon as possible, ideally within the first few hours after injury, to minimise the risk of complications such as neurovascular damage or post-traumatic arthritis. While awaiting reduction, the affected limb is immobilised, and precautions are taken to prevent further injury.
Definitive Treatment
Definitive treatment is closed reduction, performed under deep sedation or general anaesthesia. Once reduction is achieved, it is confirmed with X-rays or CT to ensure proper positioning of the femoral head and to rule out associated fractures. If closed reduction is unsuccessful or there are complex bone injuries, surgical reduction is indicated.
Afterwards, the patient should begin a rehabilitation regimen with weight-bearing restrictions on the affected limb for several weeks, followed by physiotherapy to restore mobility and strength. Regular follow-up is crucial to detect long-term complications such as avascular necrosis or joint instability.
Comments