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Hip Dislocation in Emergency Medicine Clinical Presentation

  • Author: Stephen R McMillan, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Apr 11, 2016
 

History

A high index of suspicion for hip dislocation must be present whenever evaluating a patient involved in a major trauma such as an MVC, significant fall, or an athletic injury.

Patients with a hip dislocation will be in severe pain. They may complain of pain to the lower extremities, back, or pelvic areas.

Patients will have difficulty moving the lower extremity on the affected side and may complain of numbness or paresthesias.

Frequently, patients will be a victim of multiple trauma and may not pinpoint pain to the hip as a result of altered mental status or distracting injuries.

Patients with a total hip replacement may present differently (see Special Concerns).

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Physical

As with any major trauma victim, assessment of the airway, breathing, and circulation are of primary importance. During the secondary survey, an examination of the pelvic girdle and hip are mandatory. Examination should consist of inspection, palpation, active/passive range of motion, and a neurovascular examination.

Inspection

Isolated anterior and posterior dislocations have classic appearances. In practice, these appearances may be altered by the presence of fracture-dislocations or other bony abnormalities along the leg.

  • Posterior: The hip is flexed, internally rotated, and adducted.
  • Anterior: The hip is minimally flexed, externally rotated and markedly abducted

Palpation

Palpate the pelvis and lower extremity for any gross bony deformities or step-offs. In an anterior hip dislocation, the femoral head can occasionally be palpated. Large hematomas may signify vascular injury.

Range of motion

Patients with a hip dislocation have severely limited range of motion due to pain. Evaluate what the patient can do comfortably. Do not forcefully perform range of motion on a patient who cannot tolerate manipulation. Normal, painless range of motion virtually excludes hip dislocation.

Neurovascular examination

Signs of sciatic nerve injury include the following:

  • Loss of sensation in posterior leg and foot
  • Loss of dorsiflexion (peroneal branch) or plantar flexion (tibial branch)
  • Loss of deep tendon reflexes (DTRs) at the ankle

Signs of femoral nerve injury include the following:

  • Loss of sensation over the thigh
  • Weakness of the quadriceps
  • Loss of DTRs at knee

Signs of vascular injury include the following:

  • Hematoma
  • Loss of pulses
  • Pallor
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Causes

High-speed motor vehicle collisions (MVCs) are by far the leading cause of hip dislocations. Falls from significant height and sports-related injury are also among the top causes.

Hip dislocation has been noted to be one of the most common complications of total hip arthroplasty.[7]

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Contributor Information and Disclosures
Author

Stephen R McMillan, MD Resident Physician, Clinical Assistant Instructor, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center

Stephen R McMillan, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher I Doty, MD, FAAEM, FACEP Associate Professor of Emergency Medicine, Residency Program Director, Vice-Chair for Education, Department of Emergency Medicine, University of Kentucky-Chandler Medical Center

Christopher I Doty, MD, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Edward T Tham, MD Fellow in Emergency Ultrasound, Clinical Instructor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine

Edward T Tham, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Professor Clinical, Department of Emergency Medicine, State University of New York Downstate College of Medicine

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, Council of Emergency Medicine Residency Directors, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

James E Keany, MD, FACEP Associate Medical Director, Emergency Services, Mission Hospital Regional Medical Center, Children's Hospital of Orange County at Mission

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, California Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Jerome FX Naradzay, MD, Paul Carter, MD, and Edward Newton, MD, to the development and writing of this article.

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A normal anteroposterior (AP) pelvis radiograph.
Right posterior hip dislocation in a young woman following a high-speed motor vehicle collision (MVC).
Fracture-dislocation of the right hip. The bony fragments are likely part of the acetabulum.
Posterior dislocation of right hip with acetabular fracture.
Portable AP pelvis with subtle presentation of right posterior hip dislocation. Abnormal rotation is present, and the right femoral head appears smaller, indicating that it is further away.
 
 
 
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