Dislocation Of The Hip Joint

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Dislocation of the hip joint

Dislocation of the hip joint is a traumatic limb injury. It is quite rare due to the peculiarities of the anatomical structure of the bones and joints of the pelvis. The cause of dislocation of the hip joint in most cases is traffic accidents. People usually face this pathology during various collapses, explosions, falls from a height. A common characteristic feature of hip dislocation is the indirect effect of the damaging factor.

For completely different reasons and with a different frequency, dislocation of the hip joint is found in newborn children. This is a fairly widespread orthopedic pathology of newborns, which can be caused by both improper formation of the ligamentous apparatus and joints in the prenatal period, and a complicated course of childbirth. Unlike traumatic pelvic dislocation in adults, congenital hip dislocation in children is much more treatable.

Content:

• Anatomical features of the structure of the hip joint
• Types of traumatic dislocation of the hip joint
• Symptoms of a dislocated hip joint
• Diagnosis of dislocation of the hip joint
• First aid for traumatic dislocation of the hip
• Dislocation of the hip joint
• Dislocation of the hip joint in newborns

Anatomical features of the structure of the hip joint

The hip joint has two main large articulation surfaces: the acetabulum of the pelvic bone and the head of the femur (with the greater and lesser trochanters). Congruence, or in other words, the stability of the joint is provided by the fibrocartilaginous lip located at the outer edge of the acetabulum. The strength of the bone connection is provided by a powerful ligamentous apparatus, represented by both internal and external large ligaments.

The hip joint is one of the most powerful in the body, since nature is entrusted with a huge responsibility for ensuring the vertical (standing) position and normal movement of a person. In this joint, the following types of movements are performed: abduction - adduction, flexion - extension, external and internal rotation.

Types of traumatic dislocation of the hip joint

1. Posterior dislocation is most common in car accidents. Position of the limb before injury: full adduction to the trunk or slight inward rotation. In this type of injury, the head of the femur moves back and slightly upward in relation to the joint.

2. Anterior dislocation usually occurs when a fall on an outwardly turned leg. At the same time, the articular capsule breaks, and the head of the femur moves forward with a slight downward shift. Sometimes it can even shift to the area of the pubic articulation. Then they talk about the pubic (suprapubic) dislocation. If the head moves to the obturator opening, then this is obturator dislocation of the hip joint.
3. Central dislocation is characterized by protrusion of the femoral head and retraction of the greater trochanter. The acetabulum is destroyed. This is a very serious injury.

There is another classification of hip dislocation:

• posterior superior (iliac),
• posterior (sciatic),
• anteroposterior (pallet),
• anteroinferior (obturator).

According to this classification, iliac dislocation is most common.

Symptoms of a dislocated hip joint

Dislocation of the hip joint is accompanied by severe pain, as the thigh has rich innervation. The largest vessels and nerves pass in the region of this joint, damage to which can lead to serious consequences. If nerve endings are torn or compressed, the sensitivity of the feet and lower legs may disappear. Independent movements of the injured limb are impossible. When trying to move the victim, the pain in the hip joint area is significantly increased.

The forced abnormal position of the limb is visually determined depending on the type of damage and joint deformation:

• With an anterior hip dislocation, the limb rotates outward (looking at the knee joint), slight flexion and abduction to the side. With pubic dislocation, all these signs will be expressed moderately, and with obturator dislocation - more clearly.
• In case of posterior dislocation, on the contrary, the knee is turned inward, flexion of the hip and adduction of the limb to the body are expressed. With sciatic dislocation, the lower the head goes, the more pronounced the symptoms will be. Often, with a posterior (especially displaced upward) hip dislocation, a shortening of the limb is observed.
• With central dislocation, the main characteristic symptom will be severe pain, deformation of the hip joint, shortening of the limb. Mild inward or outward rotation of the knee may be observed.

Diagnosis of dislocation of the hip joint

Usually, it is not difficult to visually determine the presence of a dislocation of the hip joint. Always in the first place, the forced position of the limb is striking. Also in the thigh area, large hematomas can be observed. The absence of active and sharp soreness of passive movements serve as an additional confirmation of the diagnosis.

An X-ray in frontal and lateral projection will help determine the type of dislocation. Damage is classified according to the position of the femoral head relative to the acetabulum. In case of controversial cases, MRI is done. The images also show the presence of complications such as cracks, chips, infringement of the neurovascular bundle, etc. Often, traumatic dislocation of the hip is accompanied by a fracture of the neck or body of the femur.

Difficulties usually arise in the diagnosis of chronic hip dislocations. Over time, pain ceases to bother the patient. The limb shortening is compensated for by tilting the pelvis and bending the spine to the affected side. Accordingly, the gait changes, a lameness appears on the diseased limb. In this case, a diagnosis can be made unmistakably only after a thorough examination of the X-ray.

First aid for traumatic dislocation of the hip

It is very important to call an ambulance immediately. It is better not to move the victim until the arrival of the medical team. You can independently try to immobilize the injured limb by applying a splint from the armpit to the ankle joint. The victim must be warmed up, provided with plenty of drink. To avoid the development of painful shock, pain relief is required. A person should be transported to the hospital in a horizontal position on a hard surface.

Dislocation of the hip joint

The earliest and most effective treatment for hip dislocation is reduction. The procedure is performed only in a hospital setting under general anesthesia (anesthesia or epidural anesthesia). Local anesthesia is not used, since there is insufficient relaxation of the musculo-ligamentous apparatus in the damaged area, which interferes with the effectiveness of the manipulation. It is necessary to correct the dislocation immediately, as quickly as possible. Self-reduction is prohibited!

There are 2 main techniques for repositioning a dislocated hip joint:

• According to Janelidze. This method is used in most cases (except for suprapubic dislocation). During the procedure, the patient is placed face down on the table. The injured limb should hang freely. Wait 10-15 minutes until the leg is in a position at a right angle to the body. Then the trauma surgeon makes a series of precise movements in the knee and hip joint, thanks to which the head of the femur returns to the acetabulum. This process is accompanied by a characteristic click in the hip joint, unpleasant to the ear. A sign of a successfully adjusted dislocation is the ability to perform passive movements in all directions.
• According to Kocher. It happens that the Dzhanelidze method fails to correct the dislocation, then the more traumatic Kocher method is used. The patient lies in a horizontal position on the table, face up. The surgeon takes the injured limb in his hands by the lower leg, at this time the assistant fixes the pelvis motionlessly, then the surgeon makes a series of sharp movements and turns, thanks to which the integrity of the joint is restored.

After the dislocation is reduced, the patient is placed on a firm bed (shield) and skeletal traction is placed. A week later, when the acute pain sensations subside and the swelling subsides, a light warming massage of the thigh and lower leg muscles begins, as well as passive movements. It is important to restore normal blood circulation in the tissues. After another 2 weeks, the patient is allowed to walk on crutches. Full recovery usually occurs by 5-6 weeks.

It also happens that it is not possible to correct the dislocation using both of the above methods, then they resort to surgical treatment. Under general mask anesthesia, a small incision is made in the joint area, the head of the femur is inserted into the acetabulum, and then the integrity of the joint capsule is restored.

After using the surgical method of treating traumatic dislocation of the hip joint, the patient's recovery takes longer. The principles of postoperative therapy are the same as after conventional reduction, however, postoperative suture care is added. Daily thermometry is performed and antibiotics are prescribed.

Rehabilitation

The restoration of joint functions in full can be started 1 - 1.5 months after injury (you must strictly adhere to the recommendations of the attending physician). Prescribed with massage of the muscles of the lower leg and thigh, then shown physiotherapy and therapeutic exercises. The rehabilitation period depends mainly on the patient's age and the severity of the injury. On average, it is 1 month. Younger patients heal and recover faster than older patients.

Dislocation of the hip joint in newborns

In another way, this disease is called hip dysplasia. The cause of its occurrence is a violation of the formation of the joint even in the period of intrauterine development. Dislocation can be both unilateral and bilateral.

There are 3 types of congenital hip dysplasia:

• Pre-dislocation, in which the anatomical integrity of the joint is compromised. However, the femoral head does not leave the acetabulum area.
• Subluxation when the head of the bone is displaced to the side in relation to the acetabulum. The displacement can be of different severity.
• The actual dislocation - the head of the femur is outside the joint area.

All these changes are associated with the underdevelopment of the ligamentous apparatus of the hip joint. In the future, this leads to a violation of ossification and growth of the limb.

It is possible to determine the presence of dysplasia in a child even before the first visit to the doctor. Pay attention to the symmetry of the folds in the gluteal region, to the length of the limbs relative to each other. If you put the baby on your back and bend both legs at the knee joint at an angle of 90 ° C, and then try to spread them apart, abduction will be difficult with dysplasia.

It is recommended to start treatment of congenital hip dislocation as early as possible, since in the future it will be difficult for the baby to start walking, which will lead to lagging behind peers in physical development. The gait of such a child becomes a "duck" (the pelvis is laid back, with a step the sore leg describes a small circle). In severe cases (with complete dislocation), disability may occur, or surgical intervention may be required.

Usually, parents of such a baby are advised to use a wide swaddle. It is also useful to carry the child in a "kenguryatnik", due to which the correct position of the limb is achieved for repositioning the dislocation (flexion with simultaneous abduction). In difficult cases, use special spacer tires. If the child is already walking, then with the permission of the surgeon, use splints for walking. Massage of the affected limb and daily gymnastic exercises have a good effect.

Usually, provided that treatment and rehabilitation measures are started early, it is possible to achieve success in the shortest possible time, in 2-3 months. The kid can start walking on time, like all children. Its further development will take place without any deviations. Do not be alarmed if a child born with dysplasia and successfully completed the course of treatment went later. This is not a gross deviation, since each baby has individual developmental characteristics. The main thing is not to panic and undergo examinations by an orthopedist on time.

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.