TRAUMATIC HIP DISLOCATION
There traumatic hip dislocation This corresponds to a complete loss of contact between the head of the femur and the acetabulum, the cavity located in the pelvis. It generally occurs after a significant trauma, such as a road accident, a fall from a height, or a violent sports impact.
Dislocation is most often posterior, but it can also be anterior. It may be accompanied by a fracture of the acetabulum, femoral head, femoral neck, or damage to the nerves and surrounding tissues.
The hip must be put back in place quickly to limit the risk of complications, particularly damage to the blood supply to the femoral head. Hospitalization allows for pain management, assessment of the nerves and circulation in the limb, and the performance of necessary examinations.
UNDERSTANDING TRAUMATIC HIP DISLOCATION
RECOGNIZING THE SYMPTOMS
A traumatic hip dislocation It usually causes intense and immediate pain after an impact. The person is often unable to move the leg normally or bear weight on it.
- Severe hip pain: It appears abruptly after the trauma and increases with the slightest movement.
- Inability to move the leg: The hip seems locked and any attempt at movement is very painful.
- Abnormal position of the lower limb: The leg may be shortened or turned inwards or outwards depending on the type of dislocation.
- Tingling or loss of sensation: Damage to the sciatic nerve can cause discomfort in the buttock, thigh or leg.
- Inability to gain support: The person is usually unable to get up or walk.
A traumatic hip dislocation should be considered an emergency. Do not attempt to realign the hip yourself or move the person unnecessarily.
WHY DOES A TRAUMATIC HIP DISLOCATION OCCUR?
A traumatic dislocation occurs when the force exerted on the hip exceeds the resistance of the muscles, ligaments, and joint capsule.
ROAD ACCIDENT
A significant impact, particularly when the knee hits the dashboard, can transmit a strong energy to the femur and cause a posterior dislocation of the hip.
FALL FROM HEIGHT
A significant fall on one's side or legs can result in a dislocation, sometimes associated with a fracture of the acetabulum or femur.
SPORTS TRAUMA
Contact sports, skiing accidents, bicycle falls, or high-energy trauma can exceptionally cause a hip dislocation.
FRAGILITY OR INSTABILITY OF THE JOINT
Hip abnormalities, significant laxity, or previous surgery can promote instability, although traumatic dislocations most often occur in a healthy joint.
MAKE THE RIGHT DIAGNOSIS
The diagnosis is based on clinical examination and imaging. The priority is to confirm the dislocation, assess the neurological and vascular status of the limb, and then look for a fracture or a fragment trapped in the joint.
01 – THE CLINICAL EXAMINATION
The doctor observes the position of the leg, assesses the pain, and looks for loss of sensation, muscle weakness, or circulatory abnormalities. The function of the sciatic nerve is also checked.
02 – X-RAYS
X-rays of the pelvis and hip can confirm the dislocation, identify its direction and look for an associated fracture.
03 – THE SCAN AFTER REDUCTION
A CT scan is usually performed after the hip has been put back in place. It allows the surgeon to check that the femoral head is correctly centered and to look for a fracture, a bone or cartilage fragment, and other joint damage.
Persistent pain after reduction or significant limitation of mobility may require further investigations and specialist follow-up.
TREATING THE DISLOCATION AND STABILIZING THE HIP
The management of a traumatic hip dislocation is performed urgently. The objective is to reposition the femoral head in the acetabulum, to check the stability of the joint and to treat any associated injuries.
RELIEVE PAIN AND PROTECT THE LIMB
The leg is immobilized in a comfortable position and no weight-bearing is permitted before the medical evaluation. Pain medication is administered, and the neurological status and circulation of the limb are monitored.
REDUCE HIP
The reduction involves placing the femoral head back into the acetabulum. It is performed in the hospital, under sedation or anesthesia, in order to relax the muscles and avoid further injury.
Reduction should be performed quickly when the patient's general condition allows, as prolonged dislocation increases the risk of complications of the femoral head.
SEARCH FOR ASSOCIATED INJURIES
After the reduction, a scan can be used to look for a fracture of the acetabulum or femoral head, an intra-articular fragment or an imperfect reduction.
MONITOR HIP STABILITY
Joint stability is assessed after reduction. An unstable hip, a non-concentric reduction, or an associated fracture may require surgical intervention.
Treatment is not just about putting the hip back in place: it is also necessary to check the condition of the joint and prevent medium and long-term complications.
WHEN TO CONSIDER SURGERY?
Surgery is not always necessary for a traumatic hip dislocation. It is considered when closed reduction fails to restore a stable and properly centered joint, or when an associated injury needs to be treated.
IN CASE OF IMPOSSIBLE REDUCTION
An intervention may be necessary when the femoral head cannot be put back into place by closed reduction, particularly in the presence of a bone fragment, cartilage or tissue trapped in the joint.
IN THE PRESENCE OF AN ASSOCIATED FRACTURE
A displaced fracture of the acetabulum or femoral head may require surgical fixation to restore the shape and stability of the joint.
IN CASE OF AN UNSTABLE OR POORLY CENTERED JOINT
Surgery may be discussed when the hip remains unstable after reduction or when the joint surfaces are not properly in contact.
REHABILITATION AND RESUMPTION OF ACTIVITIES
Recovery depends on the duration of the dislocation, the possible presence of a fracture, the stability of the hip, and the condition of the muscles and nerves.
01 – PROTECT THE HIP
A period of rest and limited weight-bearing may be prescribed depending on the observed lesions and the stability of the joint.
02 – GRADUALLY RESUME SUPPORT
Weight-bearing is resumed with crutches or a walker when authorized by the doctor. Instructions depend on the reduction and any associated fractures.
03 – REGAIN MOBILITY
Physiotherapy allows you to gradually regain hip range of motion without straining the joint or causing excessive pain.
04 – STRENGTHEN THE MUSCLES
The muscle work specifically targets the gluteal muscles, thigh muscles and pelvic stabilizing muscles.
05 – MONITOR HIP DEVELOPMENT
The follow-up allows us to look for persistent pain, stiffness, instability or signs that may suggest an injury to the femoral head.
The resumption of activities depends on associated injuries and the recovery of hip stability, and not on a uniform schedule for everyone.
A CARE APPROACH TAILORED TO EACH PATIENT
A traumatic hip dislocation is not simply a matter of realigning the joint. Treatment depends on the type of dislocation, the speed of reduction, the condition of the femoral head, and any associated fractures.
The priority is to restore a properly centered and stable hip. Follow-up also considers pain, mobility, muscle strength, and sciatic nerve function.
Follow-up checks may be necessary after the trauma to monitor the consolidation of associated injuries and the evolution of the femoral head.
«"Rapid reduction and accurate assessment of associated injuries are essential to preserving hip function."»
FREQUENTLY ASKED QUESTIONS
DO YOU WANT TO BETTER UNDERSTAND YOUR PAIN?
A clinical examination combined with appropriate imaging helps to determine the origin of symptoms and identify the most suitable treatments.
