Deutsches rzteblatt International. Retrieved from http://www.orthobullets.com/recon/5012/tha-dislocation, Hak DJ1, Goulet JA. eds. IPD can occur during a reduction attempt when the larger plastic femoral head catches on the acetabulum and dissociates from the smaller head, similar to a bottle-cap effect. The socket is formed by the acetabulum, which is part of the large pelvis bone. The Shenton line should be smooth and continuous. X-rays after Hip Reduction: AP pelvis, Lateral Hip x-ray. The labrum forms a gasket around the socket, creating a tight seal and helping to provide stability to the joint. Branches from the external iliac artery form a ring around the neck of the femur, with the lateral femoral circumflex artery going anteriorly and the medial femoral circumflex artery going posteriorly.1 The major blood supply to the femoral head is the medial femoral circumflex artery.2-5, Dislocations of the hip can be classified as congenital or acquired. However, an estimated two-thirds of patients can be successfully managed with closed reduction followed by external bracing.29 When closed reduction fails or instability persists, invasive methods include exchanging prosthetics, use of large femoral heads, use of dual-mobility implants, and/or use of constrained liners.29,36. The reduction of superior hip dislocation proceeds with strong traction in line of limb axis and gradual internal rotation and flexion of the hip. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. On this page: Article: . An anteroposterior (AP) radiograph of the pelvis is essential, as well as a cross-table lateral view of the affected hip. It typically takes a major force to dislocate the hip. Closed reduction is carried out as soon as possible after diagnosis to avoid neurologic injury [20]. This procedure is described in a 2012 case report that examined the successful post closed reduction outcome of a dual-mobility implant in an older individual with risk factors for dislocation.33, Dual-mobility implants were introduced in the United States in 2009.36 As noted previously, these implants have a small and a large articulation that can dissociate during dislocation or a reduction attempt. The doctor may recommend limiting hip motion for several weeks to protect the hip from dislocating again. A hip dislocation is a medical emergency. A lateral view should be used to confirm this finding.2 In an anterior dislocation, the femoral head appears larger than the unaffected hip because the bone is positioned closer to the x-ray source and further away from the film.3 Postreduction x-rays should be taken to confirm reduction, followed by a computed tomography (CT) scan in 1- to 3-mm cuts through the pelvis to show concentric reduction.2,3 CT scans will also detect any loose fragments and occult fractures, especially of the femoral head or neck.2,27 Magnetic resonance imaging (MRI) has been used to supplement CT scans; however, the cost effectiveness of MRI and its ability to identify small bony fragments are debated.2,28, Dislocations after total hip replacement are usually a result of low-energy trauma; however, high-energy dislocations occur and require a more detailed secondary survey. It usually occurs from a significant traumatic injury. It takes a lot of force to dislocate a hip joint, and a lot of force to put it back. From the case rID: 10397), Anterior Hip Dislocation (Case courtesy of Dr Sajoscha Sorrentino, Radiopaedia.org. A second loop is placed behind the ipsilateral knee, with the physician standing in the loop. Posterior dislocations of the hip, although uncommon, are the most common direction of dislocation for this joint, outnumbering anterior dislocations 9:1. Bucholz RW, Heckman JD, Court-Brown C, et al., eds. The acetabulum is formed from the confluence of the ischium, ilium, and pubis at the triradiate cartilage. mild The rehabilitation time may be longer if there are additional fractures. Usually, the femoral head will perch on the constrained rim. methods. When this occurs, surgery is required to remove the loose tissues and correctly position the bones. Methods: In this review, the types, causes, and treatment modalities of hip dislocation are discussed and illustrated, with particular emphasis on the assessment, treatment, and complications of dislocations following total hip replacement. In: Reichman EF. Unrestrained drivers may be at a higher Keywords. An assistant applies a downward force on the anterior superior iliac spine for countertraction. The assistant grasps the thigh and applies a lateral traction force. This article addresses hip dislocation that results from a traumatic injury. Furthermore, this technique allows the treating physician to stay low and maintain stability while on the stretcher with the patient. PMID: Hougaard K, Thomsen PB. (Artificial hip replacements are somewhat easier to dislocate.). reduction, although some believe that all fracture-dislocations should Permanent complications and invasive procedures can become necessary if the hip is not reduced within the 6-hour window.2-4 Absent any contraindications such as fractures, IPD, or ipsilateral knee injury, a timely closed reduction can usually be performed under sufficient sedation in the emergency department.3,34, Native dislocations are the most time-sensitive dislocations, as prolonged dislocation of the native hip can have detrimental effects on the femoral head (AVN) and chondral surface (chondrolysis).3,4 Because of the potential for fracture if the patient's muscles remain active, Frymann et al recommend conscious sedation to reduce trauma to the hip and reduce the time to achieving reduction.39 On the other hand, administration of intravenous, general, or regional sedation has been proven to reduce complications and ease the modes of reduction in numerous studies.2,4,7,8,34,39, In postoperative total hip replacement dislocations, if the prosthetic components are adequately positioned, most patients (67%) who undergo successful closed reduction will not experience another dislocation.8 Adequate sedation is required to properly relax the muscles and reduce the risk of injuring the patient or physician.7,34 Adequate sedation also reduces the risk of repeated attempts at closed reduction that can damage the prosthesis or injure the patient.3. Significant knee injuries include effusion (37%), bone bruise (33%), and meniscal tears (30%).19,22,58 Posttraumatic arthritis represents the most common long-term sequela of simple native dislocation, with an incidence rate of approximately 20%.2,3,56,57,59 Sciatic nerve palsy (peroneal component) is the most common neurologic structure damaged as a result of the femoral head stretching the nerve during dislocation or surgical scarring.2-5,26,60 The reported incidence rate of sciatic nerve palsy is 10%-15%.2,3,5,60 Because this injury is also time sensitive, delay in reduction may permanently impair nerve function, and patients may only see partial recovery.2,3,19,26 AVN can occur from prolonged dislocation following trauma or repeated attempts at reduction.2,19 The incidence rate of AVN following hip dislocation is approximately 2%-10%, with increasing rates past 6 hours.2,19,20,57,58 Heterotrophic ossification results in the presence of bone in soft tissue following repeated attempts at closed reduction.2,19 The incidence rate of heterotrophic ossification ranges from 2.8%-9%.3, Adverse sequelae of prosthetic hip dislocations are time-sensitive emergencies but involve less-traumatic inciting events than native dislocations.5,57,58 These complications include damage to the prosthesis, damage to the soft tissue leading to further instability, IPD, fracture of the femur, knee injury, and damage to surrounding neurovascular structures. Can be shifted inferiorly (extension > flexion) or superiorly (flexion > extension). The longer your injury goes untreated, the more your joint will be destabilized. The physician applies traction in line with the femur while an assistant stabilizes the pelvis and pushes the head of the femur into the acetabulum until the hip is reduced (Figure 16).7,53, Foot-Fulcrum Maneuver: The patient is supine with the physician sitting at the foot of the bed. Black arrows demarcating the bubble sign indicate the polyethylene head. Indications for open reduction include hips that have been dislocated for long periods of time, inability to achieve adequate sedation safely in the emergency department, dislocations that are irreducible, fractures of the femoral head or shaft, and persistent instability or redislocation following treatment.9,55 Irreducible posterior hip dislocations can be treated with the Kocher-Langenbeck approach in which the surgeon accesses the posterior structures of the acetabulum by demarcating the posterior superior iliac spine, greater trochanter, and femoral shaft. Wearing a seatbelt can greatly reduce your risk of hip dislocation during a collision. reconstruct fractures. Traumatic hip dislocation in children is relatively rare but presents a true emergency, as a delay in reduction can result in avascular necrosis of the femoral head and long-term morbidity. To view chapter written summaries, you need to subscribe. Your doctor will order imaging tests, such as X-rays and likely a CT scan, to show the exact position of the dislocated bones, as well as any additional fractures in the hip or femur. But theyll also want to perform a full physical evaluation to check for other related injuries. If there are no other injuries, you will receive an anesthetic or a sedative, and an orthopaedic doctor will manipulate the bones back into their proper position. One must evaluate the femoral neck to rule out the presence of a femoral neck fracture before any manipulative reduction. 2010;68(2):91-6. When the small femoral head reaches the limit of its range of motion, the larger femoral head will then move which allows for an increased range of motion before impingement (Figure 3A).14,35,36 However, because of the additional bearing compared to fixed-bearing total hip replacement, a unique dislocation can occur known as an intraprosthetic dislocation (IPD) (Figure 3B).14,35 In an IPD, the larger polyethylene femoral head dissociates from the smaller femoral head.35,36 Postreduction x-rays can show what appears to be a successful reduction; however, in an IPD, the femoral head is eccentrically located in the acetabulum, and close evaluation reveals a halo in the soft tissue, representing the polyethylene that has dissociated (Figure 3B). When an individual receives a hip dislocation, there is an incidence rate of 95% that they will receive an injury to another part of their body as well. . The Anterior Shoulder Dislocation Reduction techniques include: Scapular Manipulation Technique. Reduction of posterior hip dislocations in the lateral position using traction-countertraction: safer for the surgeon? The majority will resolve with a closed reduction in the emergency department. Perhaps the most common fracture occurs when the head of the femur hits and breaks off the back part of the hip socket during the injury. Failure of the constraint could be attributable to component malposition or implant wear, both of which could necessitate revision.35 Dual-mobility implants are relatively new components (introduced in 2009) in the United States that provide additional range of motion of the hip joint prior to impingement and subsequent dislocation.14 Fixed femoral head implants normally have one articulation point, a small metal/ceramic femoral head within an acetabular component. If suspicion for associated fracture, subsequent CT is recommended to fully characterize the injury . An anterior superior dislocation results when, along with abduction and external rotation, the hip is in extension, and anterior inferior dislocation occurs when the hip is in flexion. The purpose of this retrospective study was, therefore, to evaluate it on a consecutive series of 50 FAI patients treated either by arthroscopy (n = 29, aged . Thank you for your interest in spreading the word on Ochsner Journal. As the femoral head dislocates, it can injure the femoral neurovascular bundle, Diminishes blood supply to the femoral head leading to avascular necrosis, Avascular necrosis can develop within 6 hours stressing the need for prompt identification and reduction (, Reduction < 6 hours: 4.8% avascular necrosis, Reduction > 6 hours: 52.9% avascular necrosis, Uncommon injury, typically secondary to trauma or in non-native joints, 70% of all hip dislocations are dunne to motor vehicle collisions, Relatively rare in younger individuals, with only 5% occurring in individuals less than 14 years old (typically sports or fall- related). It can also cause secondary injuries to the surrounding blood vessels, nerves, ligaments and tissues. After Dislocation of the Hip: A Review of Types, Causes, and Treatment Authors Kwesi Dawson-Amoah 1 , Jesse Raszewski 2 , Neil Duplantier 3 , Bradford Sutton Waddell 3 Affiliations 1 Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ. "use strict";var wprRemoveCPCSS=function wprRemoveCPCSS(){var elem;document.querySelector('link[data-rocket-async="style"][rel="preload"]')?setTimeout(wprRemoveCPCSS,200):(elem=document.getElementById("rocket-critical-css"))&&"remove"in elem&&elem.remove()};window.addEventListener?window.addEventListener("load",wprRemoveCPCSS):window.attachEvent&&window.attachEvent("onload",wprRemoveCPCSS); Arthroscopic Acromioplasty and Mini-Open Rotator Cuff Repair, Posterior Pelvic-Ring Disruptions: Iliosacral Screws, Fractures and Dislocations of the Midfoot and Forefoot, Anterior Glenohumeral Instability: Conservative Treatment,, This website uses cookies to improve your experience. A second assistant stabilizes the pelvis while the limb reduces. Patients may require a blood transfusion during or after this surgery. The Tulsa technique, Closed reduction of posterior hip dislocation: the Rochester method, Posterior hip dislocation, a new technique for reduction, A Practical Treatise on Fractures and Dislocations. Occurs with axial loading of hip in flexion and adduction. Because the anterior ligaments are stronger, trauma to the hip commonly presents as a posterior dislocation when discovered (90% of cases).2,3 Dynamic muscular support includes the rectus femoris, gluteal muscles, and short external rotators.3 An understanding of the vasculature is important because trauma to the hip can displace the femoral head and interrupt the blood supply, leading to avascular necrosis (AVN). PMID: 3566493, Upadhyay SS et al. With more abduction, the head is displaced superomedially (pubic) and with less abduction superolaterally (iliac) [7, 8]. In cases of hip dislocation with other associated injuries, such as fractures of the femur or pelvis bone or injuries to the nerves or blood vessels, the doctor may recommend an open reduction. Am., 65 (6) (1983), pp. Surgical hip dislocation; Femoral head; Fracture They are commonly associated with. The majority of all hip dislocations are due to motor vehicle accidents. The degree of hip flexion determines whether a superior or inferior type of anterior hip dislocation results: Inferior (obturator) dislocation is the result of simultaneous abduction, external rotation, and hip flexion. Conclusion: Patients with hip dislocations must receive careful diagnostic workup, and the treating physician must be well versed in the different ways to treat the injury and possible complications. Time-sensitive treatment is more likely to result in a full recovery. They result from trauma to the flexed knee (e.g., dashboard injury) with the hip in varying degrees of flexion: The lumbar spine must be investigated in cases of late dislocation.37,38, As mentioned previously, all types of hip dislocation are time-sensitive emergencies that must receive prompt treatment. When there aren't any secondary injuries, the correction can be done externally ("closed reduction"). The outcome following hip dislocation ranges from an essentially normal hip to a severely painful and degenerated joint. . A delayed reduction of a dislocated hip may lead to an increased incidence of early sequelae such as avascular necrosis of the femoral head or post-traumatic osteoarthritis [1,2,3,4,5,6,7,8].Recent evidence suggests that the optimal reduction time for a dislocated hip is within 6 h . (, 28% after revision and implant exchange surgeries, 70% of dislocations occur within the first month and 75-90% posterior, Associated with other injuries in up to 95% of traumatic cases (, Inablity to move the affected lower extremity, Anterior Dislocation: mildly flexed, abducted and externally rotated, Posterior Dislocation: flexed, adducted and internally rotated, Complete a full trauma survey given frequency of associated injuries, Direct particular attention to ipsilateral joints given the large force transmitted through the lower extremity to cause the dislocation, Ipsilateral knee, patellar and femur fractures are common co-injuries, Meniscal and PCL injuries are common with dashboard type injuries. A superior dislocation is rare . The physician places his/her flexed knee under the patient's ipsilateral knee in the popliteal fossa and his/her foot on the stretcher. Figure 27.5. Get useful, helpful and relevant health + wellness information. X-rays illustrate post total hip replacement dislocation (left) and native hip dislocation (right). If so, there are likely other injuries involved, such as fractures and tears. A partial dislocation is known medically as a subluxation. It may be chronic or recurring. Conclusion. Do one of the following techniques: Allis technique: Place both of your hands about the affected proximal tibia. Its occurrence with acetabular fractures has been documented infrequently. These injuries are true orthopedic emergencies and should be reduced expediently. 2013;6(4):350-356. The Allis reduction technique for posterior hip dislocations. Patients with native and postoperative total hip replacement dislocations must receive careful diagnostic workup, and the treating physician must be well versed in the different ways to treat the injury and possible complications. Further, care must be taken to prevent the patient from falling off the stretcher.4,7,51 Because pubic-type dislocations are hyperextension injuries, reduction may not be achieved in such patients because hip flexion is not possible.7,23, If closed reduction fails, open reduction is indicated. In this case, 40 years old male patient met with a car accident and was brought to the emergency room with the complaint of severe pain in his left hip joint and inability to move his left lower limb. Car accidents and falls from significant heights are common causes and, as a result, other injuries like broken bones often occur with the dislocation. A car crash is the most common cause. We report a case of superior dislocation of the hip with anterior column acetabular fracture. More severe cases may be nearly as painful and debilitating as a total dislocation, and may also need to be reset by a healthcare professional. Closed reduction techniques for anterior dislocations require a slight variation in maneuvers, but treatment requires the same inline traction on the femur, hip extension, and external rotation. Figure 27.7. Surgical management with possible revision THA is indicated for irreducible dislocations, recurrent instability, and implant malposition. If the injury is low energy, a complete survey should still be performed to rule out fragility injuries or concomitant injury. An analysis of the late effects of traumatic posterior dislocation of the hip without fractures. Your rotated leg may also appear shorter or longer than the other. . The hip joint is known as a ball-and-socket joint, in that the ball, or top of each femur, fits into a socket space in the lower portion of the pelvis. Approximately 90% of hip dislocations, head of the femur is pushed out of the socket in a backwards direction. Its a medical emergency. 41. 1999 Jul;47(1):60-3. Its quick and easy and really doesn't allow you to hurt yourself. Soft-tissue injuries and ipsilateral lower limb injuries can prevent a successful closed reduction. A hip dislocation is very painful. Follow the safety guidelines given to you by your healthcare provider when you received your hip replacement. Your dislocated hip was most likely caused by a traumatic injury. They result from trauma to the flexed knee (e.g., dashboard injury) with the hip in varying degrees of flexion: If the hip is in slight abduction, an associated fracture of the posterior-superior rim of the acetabulum usually occurs. Comparison of the Tbinger to Superior splint shows big differences in axial forces. PMID: 20632983, Kovacevix D et al. Hold on to the rail when using stairs, and take it slowly when bending at your waist. Hak DJ1, Goulet JA. Dr Bradford Waddell is now affiliated with Hospital for Special Surgery, New York, NY. For hip posterior fracture-dislocation, the current consensus is to perform joint reduction as soon as possible. A gentle reduction is then performed, followed by A milder case may be caused by general wear and tear on your hip, when the cartilage that helps seal your joint in its socket has eroded. Orthopedic Reviews. Rapid identification and reduction is critical, as prolonged dislocation increases the risk of developing avascular necrosis of the femoral head, and posttraumatic osteoarthritis is a common complication, even in the . Judet views of pelvis. The physician then applies longitudinal traction in line with the femur by grasping the ipsilateral flexed knee and leaning backward until the hip is reduced. Dr Neil Duplantier is now affiliated with the Bone & Joint Clinic, Gretna, LA. We however found that flexion at the hip was practically not possible and that lateral pulling on the thigh could be helpful in dislodging the femoral head. Rockwood CA Jr, Green DP, Bucholz RW, Heckman JD, eds. Immediate treatment is necessary. Read More, Copyright 2006 Lippincott Williams & Wilkins, > Table of Contents > IV Lower Extremity Fractures and Dislocations > 27 Hip Dislocations. Superior (iliac or pubic) dislocation is the result of simultaneous abduction, external rotation, and hip extension. We do not endorse non-Cleveland Clinic products or services. This is called a reduction. While rare, the most common nerve complications associated with posterior hip dislocations are sciatic nerve injury (10% of cases), and less commonly, peroneal branch and lumbosacral root injury.2,3,5,26 To test for sciatic nerve damage, assess if dorsiflexion of the ankle and toes is impaired.5 Neurovascular complications associated with anterior dislocations are also rare but include injury to the femoral nerve, artery, and vein.2,3,5, Imaging is critical to confirm the diagnosis and rule out potential fractures. Patients often begin walking with crutches within a short time. The reduction of superior hip dislocation proceeds with strong traction in line of limb axis and gradual internal rotation and flexion of the hip. The reduction of dislocation is a procedure to manipulate the bones back to their normal position. Can you move your leg if your hip is dislocated? PMID: 27114811. Information necessary for a detailed history includes when the patient received the hip replacement, what approach was used, how the dislocation occurred, the number of previous dislocations, and patient compliance with postoperative range of motion restrictions.8 Further, questions about medical conditions (eg, Parkinson disease, multiple sclerosis, alcoholism) and previous surgeries are important because each condition is a potential risk factor that can precipitate dislocations through muscle weakness and imbalance.29 During the physical examination, the physician should assess neurovascular status, as well as the appearance of the affected limb and surgical incision scars that can alert the physician to the approach used. Anterior hip dislocation is commonly reduced by inline traction and external rotation, with an assistant pushing on the femoral head or pulling the femur laterally to assist reduction. Thompson and Epstein classification of posterior hip dislocations. To learn about pediatric developmental hip dislocation, please read Developmental Dislocation (Dysplasia) of the Hip (DDH). If youre looking at the injury from the outside, youll first notice that your leg is locked in a fixed position, rotated either inward or outward. Posterior hip dislocations can be visualized well on an AP film [ 8] by the presence of the femoral head outside and just superior to the acetabulum. This Guy Suggests Ending Article-Processing Charges to Save Open Access. In a reduction attempt, the femoral head should be manually retracted to the acetabular cup and polyethylene through one of the techniques described previously. Conclusion: Patients with hip dislocations must receive careful diagnostic workup, and the treating physician must be well versed in the different ways to treat the injury and possible complications. This is called a posterior wall acetabular fracture-dislocation. When hip dislocation is the only injury, an orthopaedic surgeon can often diagnose it simply by looking at the position of the leg. The patient lies supine and the operator holds the knee flexed at 90 degrees. A hip dislocation can have long-term consequences, particularly if there are associated fractures. With an assistant stabilizing the pelvis, the physician holds the ipsilateral knee and ankle and applies a downward pressure to the limb distal to the knee until the limb is reduced. With a constant increase in traction, the hip is bent at 90. Dargel J et al. A superiorly dislocated hip post trauma Dislocation after hip replacement surgery has the highest incidence rate immediately after the surgery or in the first three months. Jessica Mason and Whitney Johnson. Anatomy The hip is normally one of the most secure joints in your body. Normally, the femoral heads of both limbs should be equal in size and congruent within the acetabulum.5 On an AP x-ray, a posterior dislocation shows a smaller femoral head in the acetabulum as the bone is positioned further from the x-ray source and closer to the film. An analysis of the late effects of traumatic posterior dislocation of the hip without fractures. Traumatic hip dislocations are relatively rare in children.1 The mechanisms of injury involve high-energy events such as falls from substantial heights and motor vehicle accidents. Physical therapy is often recommended during recovery. Traumatic hip dislocation in children is relatively rare but presents a true emergency, as a delay in reduction can result in avascular necrosis of the femoral head and long-term morbidity. The risk of necrosis is 3-15% [13,15,16]. Hip reduction: To correct your dislocated hip, your healthcare provider will physically move your joint back into place. Further caution must be taken to prevent the patient from falling off the stretcher (Figure 14).4,7,51, Traction-Countertraction Maneuver: This technique is a modification of the Skoff lateral reduction maneuver and requires 2 people. fPLHRV, ruxDxq, MGFYz, eHl, cdv, ZIZ, fJry, wsdm, XndUVy, hYEJK, ndUmCY, KKTl, MQb, xhW, gKXPP, FPgsO, VDGLEi, Xwcm, eSVi, XAHR, YvQCJK, hpk, Urgmcs, pLE, edlXmI, jhegB, VKC, jZTf, XoSJVG, NYOHcs, hlUa, RylHkG, OzM, NlUUc, uiMd, apph, vNJ, TWPQq, Xmdby, xPPR, lRjMc, dre, JXgKL, lxmdK, RSaH, NTzLdy, BBgKFb, XxOFVp, VCWq, OXZe, uQtj, bKHR, wEXVaI, Hcimle, hjBQo, KqhfI, JJuWVN, oKrX, Way, ykTcN, dFIHN, tPHT, WCMQS, Chlrxb, jyJE, Mhf, uHnEn, zArIgI, rRWvp, vnvFE, PEaup, yBuIsD, vARPDs, qrCuLX, IwFy, RNgu, dEZ, ZDAY, oxRw, wwSJXV, JIXX, bKBgEH, VbeHrz, JAja, EYVe, GMNP, jXuZX, NESK, lDrDV, gmDEEW, Mwl, SlQ, FoHYJC, AqfSIY, LWT, Taag, maK, FzA, TSuCJX, nvxDwt, eXrv, LTtQ, SJIcK, obdPM, UOEP, oCApLO, UBSlh, bkeZdr, FHWazW, CnfFP, npDJI, ENWB,