Hip Dislocation in Emergency Medicine Clinical Presentation

  • Author: Edward T Tham, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP   more...
 
Updated: Dec 6, 2010
 

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. 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.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

Christopher I Doty, MD, FACEP, FAAEM  Assistant Professor of Emergency Medicine, Residency Program Director, Department of Emergency Medicine, Kings County Hospital Center, State University of New York Downstate Medical Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

James E Keany, MD, FACEP  Medical Director, TravelMDAssist; Staff Physician, Department of Emergency Services, Mission Hospital Regional Medical Center

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

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

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

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and 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, 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 Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine 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.

References

  1. [Guideline] DeSmet AA, Dalinka MK, Alazraki NP, Daffner RH, El-Khoury GY, Kneeland JB, et al. Avascular necrosis of the hip. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. [Full Text].

  2. [Guideline] United States Preventive Services Task Force (USPSTF). Screening for developmental dysplasia of the hip: recommendation statement. 2006;[Full Text].

  3. Brooks RA, Ribbans WJ. Diagnosis and imaging studies of traumatic hip dislocations in the adult. Clin Orthop Relat Res. Aug 2000;(377):15-23. [Medline].

  4. Conway WF, Totty WG, McEnery KW. CT and MR imaging of the hip. Radiology. Feb 1996;198(2):297-307. [Medline].

  5. DeLee JC. Fracture and dislocation of the hip. In: Rockwood CA, Green DP, Bucholz RW, et al, eds. Fractures in Adults. 4th ed. Lippincott Williams & Wilkins; 1996:1756-803.

  6. Frazee BW, Park RS, Lowery D, et al. Propofol for deep procedural sedation in the ED. Am J Emerg Med. Mar 2005;23(2):190-5. [Medline].

  7. Goddard NJ. Classification of traumatic hip dislocation. Clin Orthop Relat Res. Aug 2000;11-4. [Medline].

  8. Goulet J. Hip dislocation. In: Browner B, ed. Skeletal Trauma: Basic Science, Management and Reconstruction. 3rd ed. Philadelphia, PA: Elsevier Science; 2003:chap 46.

  9. Hillyard RF, Fox J. Sciatic nerve injuries associated with traumatic posterior hip dislocations. Am J Emerg Med. Nov 2003;21(7):545-8. [Medline].

  10. Introduction: congenital hip dislocation. WrongDiagnosis Web site. Available at http://www.wrongdiagnosis.com/c/congenital_hip_dislocation/intro.htm. Accessed May 29, 2003.

  11. McNamara R. Management of common dislocation: hip dislocations. In: Roberts J, Hedges J, eds. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, PA: W. B. Saunders Co; 2004:Chap 50.

  12. Miner JR, Martel ML, Meyer M, et al. Procedural sedation of critically ill patients in the emergency department. Acad Emerg Med. Feb 2005;12(2):124-8. [Medline].

  13. Monma H, Sugita T. Is the mechanism of traumatic posterior dislocation of the hip a brake pedal injury rather than a dashboard injury?. Injury. Apr 2001;32(3):221-2. [Medline].

  14. Morrey BF. Instability after total hip arthroplasty. Orthop Clin North Am. Apr 1992;23(2):237-48. [Medline].

  15. Newton E. Femur and hip. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, PA: Mosby Elsevier; 2006:chap 53.

  16. Nordt WE 3rd. Maneuvers for reducing dislocated hips. A new technique and a literature review. Clin Orthop Relat Res. Mar 1999;260-4. [Medline].

  17. Pitetti RD, Singh S, Pierce MC. Safe and efficacious use of procedural sedation and analgesia by nonanesthesiologists in a pediatric emergency department. Arch Pediatr Adolesc Med. Nov 2003;157(11):1090-6. [Medline].

  18. Sahin V, Karakas ES, Aksu S, et al. Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study. J Trauma. Mar 2003;54(3):520-9. [Medline].

  19. Walden PD, Hamer JR. Whistler technique used to reduce traumatic dislocation of the hip in the emergency department setting. J Emerg Med. May-Jun 1999;17(3):441-4. [Medline].

  20. Yang EC, Cornwall R. Initial treatment of traumatic hip dislocations in the adult. Clin Orthop Relat Res. Aug 2000;24-31. [Medline].

 
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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.
 
 
 
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