Physical

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

Inspection

Isolated anterior dislocation has a classic appearance, as does isolated posterior dislocation. In practice, appearances may be altered by the presence of fracture-dislocation or other bony abnormalities of 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 the lower extremity for gross bony deformities or step-offs. With anterior hip dislocation, the femoral head occasionally can be palpated. A large hematoma may signify vascular injury.

Range of motion

Patients with 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 loss of sensation in the posterior leg and foot, loss of dorsiflexion (peroneal branch) or plantar flexion (tibial branch), and loss of deep tendon reflexes (DTRs) at the ankle.

Femoral nerve injury may be seen as loss of sensation over the thigh, weakness of the quadriceps, and loss of DTRs at the knee.

The patient with vascular injury may present with hematoma, loss of pulses, and pallor.

Differential Diagnoses

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Media Gallery

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.

of 5

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, MAAEM, FAAEM, FACEP Tenured Professor of Emergency Medicine, University of Kentucky College of Medicine; Vice Chair of Education, Department of Emergency Medicine, University of Kentucky Chandler Medical Center

Christopher I Doty, MD, MAAEM, FAAEM, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Residency Directors in 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 Professor and Chair, Department of Emergency Medicine, Mount Sinai St Lukes and Mount Sinai West; Vice Chair of Academic Affairs, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai

Eric L Legome, MD is a member of the following medical societies: American College of Emergency Physicians, Eastern Association for the Surgery of Trauma, New York American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Program Director, Emergency Medicine, Einstein Medical Center Montgomery

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, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine

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.