Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Hip Dislocation Clinical Presentation

  • Author: Matthew Gammons, MD; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Mar 27, 2014
 

History

See the list below:

  • The typical history of a hip dislocation during an athletic event involves 1 of 2 mechanisms.
    • Most commonly, an athlete is running and lands on the feet or flexed knees, striking the ground while the hip is flexed, adducted, and internally rotated. This type of injury has been well documented in contact sports in which participants are tackled at high speeds and land out of control with other players piling on top of them (eg, football, rugby). A similar injury may occur during high-speed racecar driving accidents.
    • The second mechanism involves an athlete landing in the splits, with the hip flexed, abducted, and externally rotated. This type of injury is more likely to be seen during sports involving jumping and landing (eg, basketball, gymnastics).
    • The mechanism in skiing and snowboarding injuries is not well described and complex, due to high speeds and additional equipment, but it is likely similar to the aforementioned mechanisms.
  • Patients often present in obvious severe pain in the hip region and upper leg. They may also complain of knee, lower leg, or even back pain.
  • Patients usually complain of the inability to walk or move their leg about the hip joint.
  • Patients may complain of numbness and/or tingling in the legs in cases involving neurovascular damage.
Next

Physical

See the list below:

  • Hip dislocations usually present with the athlete complaining of severe pain around the hip and proximal thigh.
  • Anterior hip dislocations may present in 2 different ways.
    • Superiorly displaced dislocations present with the affected hip extended and externally rotated.
    • The inferior type of anterior dislocations presents with the affected hip flexed, abducted, and externally rotated.
  • However, the affected limb of a posterior hip dislocation most commonly appears shortened, internally rotated, and adducted.
  • In those patients whose mechanism of injury suggests a posterior hip dislocation but who have no evidence of a dislocation on examination, a traumatic posterior hip subluxation should be considered. This injury carries many of the risks of a true dislocation and may be overlooked.[13]
  • Assessing the neurovascular status of the injured leg is extremely important. Nerve injury, particularly neurapraxia, is not uncommon. The sciatic nerve and the common peroneal division of the sciatic nerve are most often injured in posterior dislocations. Simple observation and palpation for bony deformity, skin color, and temperature provides clues to the vascular status of the leg. Test reflexes, strength, and sensation in the affected leg, and palpate for femoral and distal pulses.
  • The physician should also examine the patient carefully for other bony injuries. A significant amount of force is required to dislocate a hip. Studies of motor vehicle accidents have shown hip dislocations are commonly associated with knee injuries such as fractures, dislocations, and ligamentous damage. Whether or not sport-related hip dislocations have the same rates of associated knee injuries is not known; however, a careful knee examination should be performed on all patients with hip dislocations.

Related Medscape Reference topics

Fracture, Knee

Knee Injury, Soft Tissue

Peripheral Nerve Injuries

Traumatic Peripheral Nerve Lesions

Previous
Next

Causes

See the list below:

  • High-speed, high-impact sports are the most common setting for hip dislocations.
    • Unsafe and poorly maintained playing surfaces may add to the risk of participating in high-impact sports. For instance, wet surfaces provide an environment where athletes are more prone to lose control of their bodies while running and jumping. However, no evidence exists to link these factors with an increased incidence of hip dislocations.
    • One case report describes a basketball player who slipped on a wet court and dislocated his hip.[5]
  • Although warming up before an activity and stretching on a regular basis may help prevent some sporting injuries, no evidence suggests that this decreases the risk of hip dislocation.
  • No correlation exists between athletic experience and hip dislocations.
Previous
 
 
Contributor Information and Disclosures
Author

Matthew Gammons, MD Assistant Clinical Professor, Department of Family and Community Medicine, Medical College of Wisconsin; Medical Director, Castleton State College; Consulting Staff, Vermont Orthopaedic Clinic and Killington Medical Clinic

Matthew Gammons, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, American Society of Mechanical Engineers

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.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Institute of Ultrasound in Medicine, North American Spine Society, International Spine Intervention Society, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine

Disclosure: Received honoraria from Cephalon for speaking and teaching; Received honoraria from Endo for speaking and teaching; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Prostakan for speaking and teaching; Received consulting fee from Pfizer for speaking and teaching.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Alexander Zlidenny, MD, and Federico E Vaca, MD, FACEP, to the development and writing of this article.

References
  1. Mitchell JC, Giannoudis PV, Millner PA, Smith RM. A rare fracture-dislocation of the hip in a gymnast and review of the literature. Br J Sports Med. 1999 Aug. 33(4):283-4. [Medline]. [Full Text].

  2. Rockwood CA, Green DP, Bucholz PW, Heckman JD, eds. Fractures and dislocations of the hip. Fractures in Adults. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1996. Vol 2: 1756-1803.

  3. Yates C, Bandy WD, Blasier RD. Traumatic dislocation of the hip in a high school football player. Phys Ther. 2008 Jun. 88(6):780-8. [Medline].

  4. Liporace FA, Dasti UR, Raiszadeh K. Ipsilateral anterior then irreducible posterior hip dislocation without fracture: a case report. J Orthop Trauma. 2008 May-Jun. 22(5):363-7. [Medline].

  5. Tennent TD, Chambler AF, Rossouw DJ. Posterior dislocation of the hip while playing basketball. Br J Sports Med. 1998 Dec. 32(4):342-3. [Medline]. [Full Text].

  6. Pallia CS, Scott RE, Chao DJ. Traumatic hip dislocation in athletes. Curr Sports Med Rep. 2002 Dec. 1(6):338-45. [Medline].

  7. Matsumoto K, Sumi H, Sumi Y, Shimizu K. An analysis of hip dislocations among snowboarders and skiers: a 10-year prospective study from 1992 to 2002. J Trauma. 2003 Nov. 55(5):946-8. [Medline].

  8. Collins J, Trulock S, Chao D. Field management and rehabilitation of an acute posterior hip dislocation in a professional football player. Pro Football Athletic Trainer. Summer 2001. 19(1):1,3. [Full Text].

  9. Schmidt GL, Sciulli R, Altman GT. Knee injury in patients experiencing a high-energy traumatic ipsilateral hip dislocation. J Bone Joint Surg Am. 2005 Jun. 87(6):1200-4. [Medline].

  10. Kovacevic D, Mariscalco M, Goodwin RC. Injuries about the hip in the adolescent athlete. Sports Med Arthrosc. 2011 Mar. 19(1):64-74. [Medline].

  11. Blankenbaker DG, De Smet AA. Hip injuries in athletes. Radiol Clin North Am. 2010 Nov. 48(6):1155-78. [Medline].

  12. Rancan M, Esser MP, Kossmann T. Irreducible traumatic obturator hip dislocation with subcapital indentation fracture of the femoral neck: a case report. J Trauma. 2007 Jun. 62(6):E4-6. [Medline].

  13. Cooper DE, Warren RF, Barnes R. Traumatic subluxation of the hip resulting in aseptic necrosis and chondrolysis in a professional football player. Am J Sports Med. 1991 May-Jun. 19(3):322-4. [Medline].

  14. Yang EC, Cornwall R. Initial treatment of traumatic hip dislocations in the adult. Clin Orthop Relat Res. 2000 Aug. 377:24-31. [Medline].

  15. Dreinhofer KE, Schwarzkopf SR, Haas NP, Tscherne H. Isolated traumatic dislocation of the hip. Long-term results in 50 patients. J Bone Joint Surg Br. 1994 Jan. 76(1):6-12. [Medline]. [Full Text].

  16. Hendey GW, Avila A. The Captain Morgan technique for the reduction of the dislocated hip. Ann Emerg Med. 2011 Dec. 58(6):536-40. [Medline].

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

  18. Seltzer SE, Weissman BN, Braunstein EM, et al. Indications for CT scanning in orthopedic disorders of hip. Orthop Rev. 1983. 12:29-40.

  19. Epstein HC. Posterior fracture-dislocations of the hip: comparison of open and closed methods of treatment in certain types. J Bone Joint Surg Am. Dec 1961. 43A:1079-98. [Full Text].

  20. Cash DJ, Nolan JF. Avascular necrosis of the femoral head 8 years after posterior hip dislocation. Injury. 2007 Jul. 38(7):865-7. [Medline].

  21. Grissom L, Harcke HT, Thacker M. Imaging in the surgical management of developmental dislocation of the hip. Clin Orthop Relat Res. 2008 Apr. 466(4):791-801. [Medline].

  22. Hartofilakidis G, Yiannakopoulos CK, Babis GC. The morphologic variations of low and high hip dislocation. Clin Orthop Relat Res. 2008 Apr. 466(4):820-4. [Medline].

  23. Jacob JR, Rao JP, Ciccarelli C. Traumatic dislocation and fracture dislocation of the hip. A long-term follow-up study. Clin Orthop Relat Res. 1987 Jan. 214:249-63. [Medline].

  24. Kapicioglu MI, Korkusuz F. Diagnosis of developmental dislocation of the hip by sonospectrography. Clin Orthop Relat Res. 2008 Apr. 466(4):802-8. [Medline].

  25. Kohler R, Seringe R. [Congenital dislocation of the hip: current concepts as a preliminary for diagnosis and treatment] [French]. Rev Chir Orthop Reparatrice Appar Mot. 2008 May. 94(3):217-227. [Medline].

  26. Pascarella R, Maresca A, Cappuccio M, Reggiani LM, Boriani S. Asymmetrical bilateral traumatic fracture dislocation of the hip: a report of two cases. Chir Organi Mov. 2008 May 26. epub ahead of print. [Medline].

  27. Weber M, Ganz R. Recurrent traumatic dislocation of the hip: report of a case and review of the literature. J Orthop Trauma. 1997 Jul. 11(5):382-5. [Medline].

Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.