MANUAL MINORS
A hip dislocation is a medical emergency that occurs when the femoral head is displaced out of the acetabulum, usually due to high-energy trauma, such as car accidents or falls from heights. This injury is severe because it can compromise the blood supply to the femoral head and cause neurovascular damage or associated injuries like fractures.
Diagnosis
The diagnosis is based on a history of significant trauma with severe pain, inability to move the affected limb, and visible hip deformity. Physical examination may reveal shortening of the affected leg and internal rotation (in posterior dislocations) or external rotation (in anterior dislocations).
Pelvic X-rays confirm the diagnosis by showing the displacement of the femoral head from the acetabulum. Occasionally, a computed tomography (CT) scan may be needed to assess associated fractures.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Femoral neck fracture | Hip pain, but no displacement of the femoral head from the acetabulum |
Intertrochanteric fracture | Seen on X-ray without loss of joint congruence |
Avascular necrosis of the femoral head | Chronic presentation, not related to acute trauma |
Acetabular labrum tear | Pain with movement but without deformity or evident instability |
Hip contusion | Pain without visible femoral head displacement on X-rays |
Emergency Management
Initial management of a hip dislocation involves urgent closed reduction, which must be performed under sedation or general anaesthesia to prevent permanent damage to the articular cartilage and femoral head. The goal is to restore joint congruence as quickly as possible to reduce the risk of avascular necrosis.
While awaiting reduction, the limb should be immobilised, and analgesia provided. If closed reduction is unsuccessful or associated fractures are present, surgical reduction may be necessary.
Definitive Treatment
After reduction, definitive treatment varies depending on the joint’s stability and the presence of associated injuries. In uncomplicated cases, rest with weight-bearing restrictions on the affected limb is recommended, followed by physiotherapy to restore joint function.
If fractures, cartilage injuries, or instability are present, further surgical intervention, such as internal fixation or even arthroplasty in severe cases, may be required. Long-term follow-up is essential to monitor for complications such as avascular necrosis or post-traumatic arthritis.
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