History
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.
Physical Examination
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. [14]
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
-
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.
