Review Article

Hip Dislocation : Evaluation and

Management
David M. Foulk, MD,
Brian H. Mullis, MD

Copyright 2010 by the American Academy of Orthopaedic Surgeons.

 Abstract
• Simple hip dislocation is one without fracture
of the proximal femur or acetabulum.
• Complex fracture-dislocations involve the
acetabulum, femoral head, or femoral neck.
 Mechanism of Injury
• The most common mechanism of injury is
dashboard injury in a motor vehicle accident.
• The main determinants of the type of hip
injury incurred are the amount and direction
of applied load and the position of hip at the
time the load is sustained.
 Anatomy
• The stability of the hip joint is dependent on
the bony architecture and its soft tissue
constraints.
• Primary blood supply to femoral head is
derived from the medial femoral circumflex
artery through retinacular arteries originating
from extracapsular ring at the base
 Diagnosis
• Physical examination:
– Posterior dislocation results in flexed, adducted,
and internally rotated leg.
– Anterior dislocation results in an externally
rotated posture in combination with slight flexion
and abduction.
• Plain radiograph
– AP pelvic radiograph should be obtained when hip
injury is suspected
 Management
Ultimate goal of management is to restrore
blood flow to the femoral head

• Closed reduction
• Open reduction
• Arthroscopy
• Rehabilitation
 Closed Reduction
• Closed reduction should be considered
emergently to reduce the period of
avascularity to the hip
• Usually accomplished via traction in line with
the deformity
 Open Reduction
• Open arthrotomy is the standard method for
removal of incancerated fragments
• If the fragment originates from the posterior wall,
is large enough for hardware fixation, and causes
instability on an intraoperative stress test, then it
should be fixed with open reduction and internal
fixation.
• If the size of the fragment does not cause
instability and if the fragment is too small for
surgical fixation, then it can be confidently
excised.
 Arthroscopy
• Arthroscopy is a safe alternative to arthrotomy
for addresing intra-articular pathology, and it
has several advantages over arthrotomy,
including less disruption of the
capsuloligamentous structures of the hip, less
blood loss, reduced potential for
neurovascular injury, and decreased recovery
time
 Rehabilitation
• Rehabilitation after redution and/or surgical
intervention is controversial
• Many suggest a short period of skeletal traction until
pain is improved
• Some advocate non-weight bearing for days to months,
with intent of reducing the likelihood of femoral head
collapse in patients who develop osteonecrosis. Some
reported that prolonged non-weight bearing has no
significant impact on the incidence of osteonecrosis.
• Given a lack of evidence to support a routine
postdislocation protocol, return to weight bearing
should be left to the surgeon’s discretion.
 Outcome
• Factor in deciding outcome:
– Time to reduction of the femoral head
– Initial damage incurred at the time of injury

• Good to excellent long term outcomes are

reported in half to nearly all patient with simple
hip dislocations managed with rapid reduction
 Complications
• Most common : Posttraumatic coxarthrosis
• Osteonecrosis
• Sciatic nerve palsy
Thank you