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Traumatic Hip Dislocations

  • Mark RickmanEmail author
  • Lorenz Büchler
Chapter
Part of the Fracture Management Joint by Joint book series (FMJJ)

Abstract

Pure hip dislocations are relatively unusual, but represent an injury with significant capacity for resulting in long-term disability. The femoral head most commonly dislocates posteriorly (80–90%), typically caused by axial force on the femur with the hip flexed as seen in dash board injuries. Concomitant pathomorphologies of the hip such as cam-type impingement, or femoral retrotorsion are a risk factor for posterior dislocation. Anterior dislocations are not that unusual, forming approximately 10% of most series. Other forms of pure dislocation are very unusual, i.e. obturator and central dislocation and are mostly a fracture dislocation. Early reduction is essential to improve outcome, and certainly within 12 h of injury, although as early as is safely possible is ideal. CT scanning is the current standard imaging; examination under anesthesia to assess stability aids planning and early post-operative mobility is probably beneficial. Surgery is reserved for irreducible dislocations, associated fractures, incongruence after reduction, or significant instability found at examination under anesthesia (EUA). Long-term hip outcomes are mostly excellent or good, but avascular necrosis (AVN) and post-injury arthritis affect up to 20% of cases. Associated injuries are common in this group, and often determine the overall patient outcome.

Keywords

Hip Joint dislocation Traumatic dislocation Obturator dislocation Femoral head Open reduction Closed reduction Hip outcome 

References

  1. 1.
    Hak DJ, Goulet JA. Severity of injuries associated with traumatic hip dislocation as a result of motor vehicle collisions. J Trauma. 1999;47(1):60–3.CrossRefGoogle Scholar
  2. 2.
    Monma H, Sugita T. Is the mechanism of traumatic posterior dislocation of the hip a brake pedal injury rather than a dashboard injury? Injury. 2001;32(3):221–2.CrossRefGoogle Scholar
  3. 3.
    Cornwall R, Radomisli TE. Nerve injury in traumatic dislocation of the hip. Clin Orthop Relat Res. 2000;377:84–91.CrossRefGoogle Scholar
  4. 4.
    Hillyard RF, Fox J. Sciatic nerve injuries associated with traumatic posterior hip dislocations. Am J Emerg Med. 2003;21(7):545–8.CrossRefGoogle Scholar
  5. 5.
    Epstein HC. Traumatic dislocations of the hip. Clin Orthop Relat Res. 1973;92:116–42.CrossRefGoogle Scholar
  6. 6.
    Upadhyay SS, Moulton A, Burwell RG. Biological factors predisposing to traumatic posterior dislocation of the hip. A selection process in the mechanism of injury. J Bone Joint Surg. 1985;67(2):232–6.CrossRefGoogle Scholar
  7. 7.
    Steppacher SD, Albers CE, Siebenrock KA, Tannast M, Ganz R. Femoroacetabular impingement predisposes to traumatic posterior hip dislocation. Clin Orthop Relat Res. 2013;471(6):1937–43.CrossRefGoogle Scholar
  8. 8.
    Berkes MB, Cross MB, Shindle MK, Bedi A, Kelly BT. Traumatic posterior hip instability and femoroacetabular impingement in athletes. Am J Orthop (Belle Mead NJ). 2012;41(4):166–71.Google Scholar
  9. 9.
    Manner HM, Mast NH, Ganz R, Leunig M. Potential contribution of femoroacetabular impingement to recurrent traumatic hip dislocation. J Pediatr Orthop B. 2012;21(6):574–8.CrossRefGoogle Scholar
  10. 10.
    Krych AJ, Thompson M, Larson CM, Byrd JW, Kelly BT. Is posterior hip instability associated with cam and pincer deformity? Clin Orthop Relat Res. 2012;470(12):3390–7.CrossRefGoogle Scholar
  11. 11.
    Thompson VP, Epstein HC. Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twenty-one years. J Bone Joint Surg Am. 1951;33-a(3):746–78.CrossRefGoogle Scholar
  12. 12.
    Upadhyay SS, Moulton A, Srikrishnamurthy K. An analysis of the late effects of traumatic posterior dislocation of the hip without fractures. J Bone Joint Surg. 1983;65(2):150–2.CrossRefGoogle Scholar
  13. 13.
    Paus B. Traumatic dislocations of the hip; late results in 76 cases. Acta Orthop Scand. 1951;21(2):99–112.CrossRefGoogle Scholar
  14. 14.
    Stewart MJ, Milford LW. Fracture-dislocation of the hip; an end-result study. J Bone Joint Surg Am. 1954;36(A:2):315–42.CrossRefGoogle Scholar
  15. 15.
    Brav EA. Traumatic dislocation of the hip. JBJS. 1962;44-A:1115–34.CrossRefGoogle Scholar
  16. 16.
    Upadhyay SS, Moulton A. The long-term results of traumatic posterior dislocation of the hip. J Bone Joint Surg. 1981;63b(4):548–51.CrossRefGoogle Scholar
  17. 17.
    Kellam P, Ostrum RF. Systematic review and meta-analysis of avascular necrosis and posttraumatic arthritis after traumatic hip dislocation. J Orthop Trauma. 2016;30(1):10–6.CrossRefGoogle Scholar
  18. 18.
    Tannast M, Pleus F, Bonel H, Galloway H, Siebenrock KA, Anderson SE. Magnetic resonance imaging in traumatic posterior hip dislocation. J Orthop Trauma. 2010;24(12):723–31.CrossRefGoogle Scholar
  19. 19.
    Kanakaris NK, Giannoudi MP. Fractures-dislocations of the hip. In: Lasanianos NG, Kanakaris NK, Giannoudis PV, editors. Trauma and orthopaedic classifications. A comprehensive overview. London: Springer; 2014. p. 293–8.Google Scholar
  20. 20.
    Allis OH. XI. Everted dorsal dislocations of the hip. Ann Surg. 1911;54(3):371–80.CrossRefGoogle Scholar
  21. 21.
    Stimson LA. Five cases of dislocation of the hip. Clin Orthop Relat Res. 1988;231:3–6.Google Scholar
  22. 22.
    Dahners LE, Hundley JD. Reduction of posterior hip dislocations in the lateral position using traction-countertraction: safer for the surgeon? J Orthop Trauma. 1999;13(5):373–4.CrossRefGoogle Scholar
  23. 23.
    Lefkowitz M. A new method for reduction of hip dislocations. Orthop Rev. 1993;22(2):253–6.PubMedGoogle Scholar
  24. 24.
    Marya SK, Samuel AW. Piggy back technique for relocation of posterior dislocation of the hip. Injury. 1994;25(7):483–4.CrossRefGoogle Scholar
  25. 25.
    Nordt WE 3rd. Maneuvers for reducing dislocated hips. A new technique and a literature review. Clin Orthop Relat Res. 1999;360:260–4.CrossRefGoogle Scholar
  26. 26.
    Schafer SJ, Anglen JO. The East Baltimore lift: a simple and effective method for reduction of posterior hip dislocations. J Orthop Trauma. 1999;13(1):56–7.CrossRefGoogle Scholar
  27. 27.
    McKee MD, Garay ME, Schemitsch EH, Kreder HJ, Stephen DJ. Irreducible fracture-dislocation of the hip: a severe injury with a poor prognosis. J Orthop Trauma. 1998;12(4):223–9.CrossRefGoogle Scholar
  28. 28.
    Canale ST, Manugian AH. Irreducible traumatic dislocations of the hip. J Bone Joint Surg Am. 1979;61(1):7–14.CrossRefGoogle Scholar
  29. 29.
    Schlickewei W, Elsasser B, Mullaji AB, Kuner EH. Hip dislocation without fracture: traction or mobilization after reduction? Injury. 1993;24(1):27–31.CrossRefGoogle Scholar
  30. 30.
    Keene GS, Villar RN. Arthroscopic loose body retrieval following traumatic hip dislocation. Injury. 1994;25(8):507–10.CrossRefGoogle Scholar
  31. 31.
    Mullis BH, Dahners LE. Hip arthroscopy to remove loose bodies after traumatic dislocation. J Orthop Trauma. 2006;20(1):22–6.CrossRefGoogle Scholar
  32. 32.
    Wylie JD, Abtahi AM, Beckmann JT, Maak TG, Aoki SK. Arthroscopic and imaging findings after traumatic hip dislocation in patients younger than 25 years of age. J Hip Preserv Surg. 2015;2(3):303–9.CrossRefGoogle Scholar
  33. 33.
    Fowler J, Owens BD. Abdominal compartment syndrome after hip arthroscopy. Arthroscopy. 2010;26(1):128–30.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and TraumaUniversity of AdelaideAdelaideAustralia
  2. 2.Department of Orthopaedics and Trauma, Royal Adelaide HospitalAdelaideAustralia
  3. 3.Department of Orthopaedic SurgeryKantonsspital AarauAarauSwitzerland

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