MANUAL MINORS
Central hip dislocation is a severe injury where the femoral head shifts medially, passing through the fractured acetabulum into the pelvis. This dislocation is always accompanied by an acetabular fracture due to high-energy trauma, such as car accidents or falls from heights. It is a medical emergency because it can compromise blood vessels, nerves, and cause intra-abdominal injuries.
Diagnosis
Clinical diagnosis includes severe pain in the hip and groin, inability to move the affected leg, and shortening or deformity of the limb. The pelvis may present with a palpable internal protrusion of the femoral head. A pelvic X-ray confirms the diagnosis, showing medialisation of the femoral head and fractures of the acetabulum. A computed tomography (CT) scan is essential to assess the extent of bone damage and to rule out associated injuries.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Posterior hip dislocation | Femoral head shifts backwards, with internal rotation of the leg |
Anterior hip dislocation | Femoral head shifts forwards, with external rotation of the leg |
Femoral neck fracture | No displacement into the pelvis, although the femoral head may shift |
Acetabular fracture without dislocation | No loss of congruence between the femoral head and acetabulum |
Avascular necrosis of the femoral head | Chronic presentation, without a history of acute trauma |
Emergency Management
Emergency management includes stabilising the patient, pain control with potent analgesics, and, in the case of open fractures or associated injuries, treatment with antibiotics and tetanus prophylaxis.
Hip immobilisation is key until surgical intervention can be performed. It is essential to rule out associated intra-abdominal or vascular injuries, and a detailed abdominal and pelvic evaluation is recommended, especially in patients with high-energy trauma.
Definitive Treatment
Definitive treatment is surgical, with open reduction and internal fixation of the acetabulum and femoral head. This procedure aims to restore hip anatomy and prevent complications such as avascular necrosis or post-traumatic arthritis.
The prognosis depends on the extent of associated injuries and the time elapsed before reduction. After surgery, the patient will require prolonged rehabilitation, with weight-bearing restrictions on the affected leg and follow-up imaging to monitor fracture healing and the viability of the femoral head.
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