Hip Dislocation - Causes, Symptoms and Treatment. MF.

Dislocation of the femur - a pathological displacement of the head of the femur beyond the acetabulum. The hip joint is one of the most protected in the body, it is surrounded by a considerable amount of muscles and a powerful ligament apparatus. Therefore, hip dislocation can occur only when exposed to a significant external force - most often this occurs in an accident or when falling from a height.

Congenital dislocation occurs with severe degree of dysplasia( underdevelopment) of the hip joint. In this case, the pathological mobility of the head of the femur becomes possible. More on congenital hip dislocation, symptoms and treatment in the article "Hip Dysplasia and Congenital Hip Dislocation" & gt; & gt;

In this article, we will consider in more detail the traumatic dislocation of the hip. Traumatic dislocation, as is clear from the name, is a consequence of the impact of external force. Depending on the direction of its application and the position of the limb at the time of traumatic impact, a multidirectional displacement of the femur is possible. Thus, the following types of traumatic dislocations of the hip are distinguished:

• When the injuring force is applied to the bent limb( most often this happens in an accident), a posterior dislocation of the hip occurs, which is subdivided into the posterior-upper and posterior-lower extremities.
• If the injury was caused with a straightened and slightly developed back of the limb( when falling from a height, taking extreme sports) - there is anterior dislocation of the hip with a similar division into antero-top and front-bottom.

Symptoms of hip dislocation

Obligatory and most characteristic of any traumatic hip dislocation symptoms are the pathological position and limb mobility limitation.

With the posterior hamstrings of the thigh , the forced position is characterized by bringing and turning the inside of the limb bent( with the rear-bottom) or straightened( with the rear-upper dislocation).

At the front dislocations of the , the limb is outwardly deployed and retracted; similar to the rear dislocations, it can be bent( with the front-bottom dislocations) or straightened( with the front-upper dislocation).

Active movements in the hip joint with dislocation are absent, passive are extremely painful and also limited in volume. Characteristic is "springy mobility," when an attempt is made to change the position of the limb, resistance is felt and it returns to its original state.

Forced limb position with a hip dislocation

For palpation, the displaced femoral head is defined, depending on the direction of the dislocation, it can be determined in the gluteal region or in the groin.

Differential Diagnosis with Dislocation of the Thigh

The dislocation of the hip should be distinguished from bruises, subluxations and various fractures of the femoral or pelvic bones.

• Contusion is characterized by soreness in the hip joint area while maintaining the full volume of passive and significant volume of active movements.
• With subluxation, the symptoms are much less pronounced, a small amount of active limb movements remain.
• Fractures of the neck of the hip and acetabulum can simulate a hip dislocation, often accompany it.
• Femur fractures are marked by a pronounced deformity of the limb, tenderness in the fracture site, retention of passive movements in the joints.
• With fractures of the pelvis, limbs retain mobility, soreness occurs when pressure is applied to the pelvis.

First aid for suspected hip dislocation

Do not try to fix the dislocation yourself! This can lead to very serious consequences from the complication of the adjustment of the dislocation to the ruptures of ligaments, tendons, cartilage damage of the acetabulum. Any attempts to independently fix the dislocation lead to an extension of the rehabilitation period.

It is vital in case of injury to the pelvic area urgently call an ambulance or Emergency Ministry.
First of all, if a suspected dislocation of the hip is suspected, the victim should be anesthetized. To do this, he is injected with analgesics( analgin, ketones, or any other available) intramuscularly.

Further it is necessary to provide immobilization( immobility) of the damaged limb. If there is a special tire( flexible or analogous to the Dieterichs bus) - it is necessary to fix the limb by means of the tire in the position in which it is located.

If there is no such tire, it is advisable to make its analogs from improvised materials - sticks, branches, any hard objects of the required size. Before the imposition, an improvised tire is wound with a bandage or clothing, or the clothes are put under the tire. It is also possible to pribintovat the affected limb to a healthy elastic or ordinary bandage, or by any means, including the clothes of the victim.

You can put a cold compress on the projection of the hip joint.

Self-transportation of the injured person is extremely undesirable. However, if there is no other way to deliver it to the health care institution, it is necessary to transport it on a firm surface.

Confirmation of the diagnosis of

A victim who has been suspected of a traumatic dislocation will be examined and interviewed by a specialist with a suspected traumatic dislocation, prostheses the region of the hip joint to suggest a mechanism of injury and a direction of displacement of the head of the femur.

Obligatory is the x-ray examination of the joint area in two projections to specify the type of dislocation and exclusion of concomitant damage to surrounding tissues.

Radiography of a hip dislocation

Treatment of a hip dislocation

In all cases of traumatic dislocation of the thigh, the patient needs emergency hospitalization. The method of treatment of traumatic dislocation depends on its severity and the presence or absence of concomitant damage to soft tissues and bone.

With uncomplicated hip dislocation after radiography and clarification of the type of dislocation the patient is transferred to the operating room. The direction of the dislocation is necessarily under anesthesia and against the background of the introduction of muscle relaxants( substances that relax the musculature).The technique of correcting various dislocations of the hip is markedly different. In general, when the dislocation is dislocated, the physician repeats in the reverse order the effect leading to trauma. Thus, the head of the femur seems to repeat its path, returning as a result to the acetabulum.

In cases of complicated dislocations, an operation is often required to suture the ruptured ligaments and / or put bone fragments in place.

Strictly obligatory is the postal regime in the post-traumatic period.

The further tactics of treatment are individual. Uncomplicated dislocations require immobilization for up to three weeks and in the future - the use of crutches for a period of 10 days to two months. With a successful rehabilitation, these terms can be reduced.

If there are concomitant damages, it can be shown the imposition of a plaster bandage, skeletal traction or bone fixation. In such cases, the duration of treatment can significantly increase.

In all cases, the treatment for dislocation of the hip occurs under the constant supervision of a traumatologist with the implementation of control X-ray images, evaluation of the success of the prescribed treatment, the speed of restoration of the joint function and the appropriate correction of the current treatment.

Rehabilitation after a hip dislocation

Rehabilitation after a traumatic hip dislocation is quite long. In the case of an ideally uncomplicated dislocation, which managed to be corrected without surgical intervention, the minimum period of the subsequent bed rest is two weeks. Already during the stay on the bed, the treatment includes physical therapy, massage and physiotherapy. Such treatment is effective only in a complex. That is, it is meaningless to hope that you can make a massage - and the limb will recover.

Massage with a hip dislocation

Complex rehabilitation begins with a massage. In the first sessions this is relatively gentle effects - stroking and rubbing, designed to restore blood flow in the damaged areas for more effective treatment. Further, the massage becomes more intense - with mending techniques and exercise sessions begin.

Physiotherapy with dislocation of hip

Exercise exercises are distributed according to the same principle - from simpler to more complex and active. The first sessions of exercise therapy are aimed at maintaining an effective blood flow in the muscles to prevent their atrophy. Exercises at this stage are easy, not requiring active movements. At the next stage, exercises are added to preserve mobility in the joint, which requires the implementation of a set of active and passive movements - starting with flexion-extension and for several sessions widening the range of movements by rotation and reduction-reduction. Well, in the future, the exercises are aimed at restoring the full work of the joint and may include training on simulators, walking and even running.

Physiotherapy with a hip dislocation

Physiotherapy procedures include magnetotherapy, UHF, diadynamic currents, thermal procedures and other kinds of influences. A specific program of physiotherapeutic treatment is selected in each case individually by a doctor of the appropriate profile, taking into account the patient's needs and the possibilities of the medical institution.

Forecast for dislocation of hip

The prognosis for uncomplicated hip dislocation is favorable, after the completion of the course of medical measures, a full recovery comes. With the timely and full treatment of complicated dislocations, complete recovery is also possible, but the likelihood of degenerative joint diseases( arthritis, arthrosis) in the long-term prognosis increases.

Rev.doctor of traumatologist-orthopedist Savchenko V.R.