Hip Dislocation - Symptoms, Diagnosis And Treatment Of Hip Dislocation. Prevention

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Hip dislocation

Dislocations in the hip area make up no more than 5% of the total dislocations. Typically, damage is formed as a result of a sufficiently strong application of traumatic force, carried out at high speed. For example, this can happen during an accident, falls from a significant height, with various collapses.

Posterior hip dislocation is a more common injury. It occurs with a sharp bend or rotation of the hip inward. Then the posterior part of the capsule of the hip joint is torn apart by the head of the femur, which emerged from the acetabulum. The position of the dislocated head of the joint determines whether the dislocation is iliac or sciatic.

Anterior hip dislocation is a rarer injury. It is indirect and can occur if a person falls from a height on the leg that is laid aside. The femoral head will move downward, severing the joint capsule. Anterior dislocations are obturator and pubic.

Separately, congenital dislocation of the hip should be considered, which occurs due to improper intrauterine development of the fetus. This pathology is quite common, and in the case of its timely detection and adequate treatment, the functioning of the joint is fully restored. Otherwise, congenital hip dislocation threatens the child with lameness, "duck gait" and pain syndrome.

Content:

• Symptoms of a hip dislocation
• Causes of hip dislocation
• Types of hip dislocation
• Diagnostics of the hip dislocation
• Hip dislocation treatment
• Prevention of hip dislocation

Symptoms of a hip dislocation

Symptoms of hip dislocation should be divided according to the type of injury. In general, the victim complains of a rather serious pain in the hip joints.

In addition to the deformity and forced position of the injured limb, the main symptom of hip dislocation is severe pain. With a posterior dislocation of the hip, the leg bends and rotates with the knee inward. The stronger the flexion, the greater the likelihood of sciatic posterior hip dislocation. Accordingly, with iliac dislocation, the leg is bent less.

For each type of hip dislocation, the following physical manifestations are characteristic:

• forced placement of a limb;
• change in the shape of the hip joint;
• strong or not, but nevertheless an obvious shortening of the leg on the side where the injury occurred.

Even the smallest displacements in the area of the presented joint are painful, sharply limited and accompanied by specific resistance. If we talk about more active movements, then they seem impossible.

In the case of an anterior dislocation, the person's limb is turned towards the outside, laid aside. At the same time, it will also be bent not only in the hip, but also in the knee joint. The anterior and inferior dislocation resolves with more obvious flexion and abduction of the injured area.

A dislocation that occurs directly in the thigh can be accompanied and with a separation of a small part of the verticular depression. In some cases, the cartilage of the top of the femur is fractured. With posterior and lower thigh injuries, severe contusion of the sciatic nerve is often determined. When dislocations of the hip are obtained in the anterior part, compression of the femoral vessels is likely, with the anterior and lower ones - strong pressure on the obturator nerves, which causes severe pain.

Dislocation of the hip, which was obtained a long time ago or is not fresh, is accompanied by much less obvious symptoms of a clinical nature, since pain in the joint area decreases over time. The change in the length and shape of the leg begins to be compensated for by tilting the pelvic region and a sudden increase in lordosis (bending in the lumbar region) of the spine.

Since hip dislocations are often combined with fractures, an X-ray examination is imperative to make a diagnosis.

The first aid for dislocation of the hip is the introduction of an anesthetic to the affected person and immediate hospitalization of the patient. In this case, you need to try so that the patient does not move.

Causes of hip dislocation

Dislocations in the hip area occur as a result of the impact of an indirect injury. In this case, it is the femur that receives the role of a specific lever that acts on the entire hip joint.

After the implementation of the forced influence, the pommel of the femur:

• tears the capsule cavity of the joint;
• destroys or damages ligaments;
• leaves, from the cavity to the area of the joints.

The cause of the posterior hip dislocation is usually a car injury. The mechanism of such a detrimental effect is a tangible rotation or extension of the limb, extended to the inner part, reduced and bent.

Dislocation of the hip in the anterior region most often occurs in the case of a fall from a height onto an abducted limb in a bent position turned to the outside.

Types of hip dislocation

The classification of hip dislocations is carried out according to several principles. First of all, the anterior and posterior dislocations of this area should be highlighted.

Dislocations in the anterior part should be subdivided into anterior and superior (supralonal), as well as anterior and inferior (obturator). The posterior ones are classified in this way: posterior and superior (iliac), as well as posterior and inferior (sciatic). Taking into account the presented classification, the process of implementation of treatment can be different, depending on the nuances of the diagnosis.

A separate category of hip dislocation is a congenital defect. Studies carried out to date have proven that dysplasia is at the base of congenital dislocation in the hip region. We are talking about a violation of the optimal formation of each of the parts of the presented joint throughout the development in the womb.

These dysfunctions of an initial nature become catalysts for further development: not the final development of the pelvic bones, movement of the top of the thigh, slowing down the process of ossification (ossification) of the described joint elements.

Diagnostics of the hip dislocation

The diagnosis of "hip dislocation" in the vast majority of cases does not cause any difficulties for a traumatologist or any other specialist. In order to clarify the position of the end of the femur and to exclude possible bone damage, it is necessary to conduct an x-ray study. Moreover, it must be in two projections.

In the same case, if the diagnosis is in doubt, an MRI scan of the entire described joint is performed.

Hip dislocation treatment

The treatment process is quite simple and implies the fastest possible reduction and a fairly short fixation. After that, it is imperative to carry out specific therapy (physiological procedures and therapeutic exercises).

A dislocation in the traumatic hip region is accompanied by a reflex contraction of the large muscles of the thigh and gluteal regions. For a successful and competent reduction, these muscles should be relaxed as best as possible. In this regard, the reduction of the femoral dislocation is carried out in inpatient treatment under integral anesthesia using muscle relaxants. This should be considered a prerequisite.

In the process of repositioning recently received anterior and lower, posterior-lower and posterior femur injuries, the Janelidze method should be used (as the least traumatic, but quite painful). If we are talking about repositioning older or fresh anterior and upper dislocations, then the Kocher method will be relevant.

In the case of anterior and superior dislocations in the thigh area, the Janelidze method is not used, because the probability of breaking the top of the femur during the reduction is too high.

After the application of skeletal traction has been carried out, it is necessary to go with it for at least three to four weeks. After that, the victim will need to move with crutches for about 10 weeks. We are also talking about the appointment of special therapy and gymnastics of a therapeutic nature.

Damage to the cartilage of the end of the hip bone during its dislocation is almost always accompanied by the development of such arthrosis of the hip joint, which becomes a catalyst for a change in its shape. An alternative name for the presented phenomenon is coxarthrosis in the long-term period.

In such situations, especially with the obvious development of disorders in the joint area, it may be necessary to undergo hip arthroplasty. For this, it is first removed, and then the prosthesis is fixed.

If we talk about congenital dislocations of the hip, then two fundamental methods of treating the presented pathology have been developed: conservative and operative (that is, surgical). If the diagnosis is made not only on time, but also correctly, then only conservative methods of treatment are used.

In such a case, a tire is individually selected for the baby, which makes it possible to hold the limbs in the following positions:

• on the bend in the hip and knee joints at an angle of 90 ° C;
• abduction in the area of the hip joints, which has a positive effect on their subsequent correct development and formation.

Reduction of the end of the femur should be carried out rather slowly, in stages and without causing any injury. In this case, any forceful action is unacceptable, because it easily damages the pommel of the thigh, as well as the rest of the joint tissues.

Treatment of a conservative nature of children with congenital dislocations of any category is the most important way. In addition, the earlier it is possible to achieve the alignment of the acetabulum and the end of the thigh, the more successful conditions will be created for the subsequent formation of the entire hip joint.

The optimal time to start treatment is the first days of a baby's life, that is, exactly the period when changes in the secondary nature in the region of the cavity and proximal top of the femur are minimal. At the same time, treatment of a conservative nature is more than applicable in case of delayed diagnosis in older children. It can also be children who have reached the age of one, that is, exactly when a fully formed dislocation in the hip area is discovered.

All activities related to the diagnosis and treatment of children with all types of hip dislocations should be carried out in the first three months of life. Any later dates should be considered late. If we talk about surgical interventions, then they are carried out in the case of older dislocations.

Prevention of hip dislocation

In order to prevent dislocation in the area, it is recommended to closely monitor safety in everyday life and in the process of playing sports.

So, there is a need for:

• training of various muscle groups, the rational receipt of physical activity;
• the use of extremely comfortable clothing and shoes to prevent falls;
• the use of professional means of protection throughout the exercise. We are talking, at least, about knee pads and hip braces;
• refusal of any trips on ice, paying attention to slippery and wet surfaces.

In order to completely restore the hip joint after a dislocation, it will take, if there are no complications, from 2 to 3 months. This period can only be lengthened if there are concomitant fractures. So, the doctor may insist that a non-long-term traction of the skeletal type with further complexes of exercises is carried out. This is done using a device of continuous inactive movement.

Self-movement using crutches is possible only in the absence of any pain. Until the moment when lameness disappears, it is recommended to resort to additional aids for the implementation of movements, for example, a cane.

After that, it is recommended to use fortifying drugs that will affect the structure of bone tissue. It is also important to carry out certain exercises, a list of which should be compiled by a specialist. The regularity of their implementation will be the key to recovery. In addition, it is necessary to treat the damaged area of the thigh as carefully as possible, because now it is it that is one of the weakest points of the body.

Remembering all the rules of prevention and treatment, it is more than possible to quickly and permanently get rid of any consequences of hip dislocation while maintaining the optimal rhythm and tone of life.

Author of the article: Kaplan Alexander Sergeevich | Orthopedist

Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.