Hip Dislocation

By: Mohammed Qasim Al-lami

 Introduction
 Hip dislocations are traumatic hip injuries that result in femoral head dislocation from the
acetabular socket.

 A traumatic hip dislocation occurs when the head of the thighbone (femur) is forced out of its
socket in the hip bone (pelvis). It typically takes a major force to dislocate the hip. Car
accidents and falls from significant heights are common causes and, as a result, other injuries
like broken bones often occur with the dislocation.

 A hip dislocation is a serious medical emergency. Immediate treatment is necessary.

 Epidemiology and Etiology
 Epidemiology: - Incidence
# rare, but high incidence of associated injuries

 Etiology:
 Pathophysiology

# mechanism is usually young patients with high energy trauma

 Pathoanatomy
• Hip joint inherently stable due to
• bony anatomy
• soft tissue constraints including
• labrum
• capsule
• ligamentum teres
 Classification
 Simple vs. Complex
• simple
• pure dislocation without associated fracture
• complex
• dislocation associated with fracture of acetabulum or proximal
femur
• Anatomic classification
• posterior dislocation (90%)
• occur with axial load on femur, typically with hip flexed and
adducted
• axial load through flexed knee (dashboard injury)  
• position of hip determines associated acetabular injury
• increasing flexion and adduction favors simple dislocation
• associated with
• osteonecrosis
• posterior wall acetabular fracture
• femoral head fractures
• sciatic nerve injuries
• ipsilateral knee injuries (up to 25%)   
 Classification
• anterior dislocation
• associated with femoral head impaction or
chondral injury
• occurs with the hip in abduction and external
rotation
• inferior ("obturator") vs. superior ("pubic")
• hip extension results in a superior (pubic) dislocation
• Clinically hip appears in extension and external rotation
• flexion results in inferior (obturator) dislocation
• Clinically hip appears in flexion, abduction, and external rotation 
 Presentation
Symptoms
• acute pain, inability to bear weight, deformity

Physical exam
• ATLS
• 95% of dislocations with associated injuries
• posterior dislocation (90%)
• most common
• associated with posterior wall and anterior femoral head fracture
• hip and leg in slight flexion, adduction, and internal rotation  
• detailed neurovascular exam (10-20% sciatic nerve injury)
• examine knee for associated injury or instability
• chest X-ray ATLS workup for aortic injury   
• anterior dislocation
• hip and leg in extension, abduction, and external rotation 
 Imaging
 Radiographs
• recommended views
• AP
• cross-table lateral
• used to differentiate between anterior vs. posterior dislocation
• scrutinize femoral neck to rule out fracture prior to attempting closed re duction
• obtain AP, inlet/outlet, judet views after reduction
• findings
• loss of congruence of femoral head with acetabulum
• disruption of shenton's line  
• arc along inferior femoral neck + superior obturator foramen
• anterior dislocation
• femoral head appears larger than contralateral femoral head
• femoral head is medial or inferior to acetabulum
• posterior dislocation  
• femoral head appears smaller than contralateral femoral head
• femoral head superimposes roof of acetabulum
• decreased visualization of lesser trochanter due to internal rotation of femur
 Imaging
 CT
• helps to determine direction of dislocation, loose bodies, and
associated fractures
• anterior dislocation  
• posterior dislocation  
• post reduction CT must be performed for all traumatic hip
dislocations to look for 
• femoral head fractures  
• loose bodies  
• acetabular fractures  

posterior dislocation anterior dislocation

 Mechanism of Injury
 Young adults are most affected by traumatic hip dislocations, mostly caused by car
accidents and is always the result of an external force with high intensity. 

 Another common mechanism is falling from a height. Hip dislocations are thus rarely
isolated, and often goes together with other injuries or fractures.
 Mechanism of Injury
 With hip dislocations, the soft tissue around the hip, such as the muscles, ligaments and
labrum are also damaged. Neural injuries may also be present. 

 Fractures to the acetabulum and femur head is most commonly associated with traumatic hip
dislocations. Hip dislocations are classified as either anterior or posterior, depending on the
displacement of the femur head in relation to the acetabulum. Posterior hip dislocations are
more common, and makes about 85-90% of the cases. 

 The position of the hip will be in flexion, adduction and internal rotation, with notable
shortening of the leg. With anterior hip dislocations, the hip will be minimally flexed and
positioned in abduction and external rotation.
 Mechanism of Injury
 Dislocation after hip replacement surgery has the highest incidence rate
immediately after the surgery or in the first three months. This is normally caused
by less trauma, usually falls or turning, moving into the contra-indicated positions,
and putting stress on the capsule that was cut to do the replacement surgery. The
incidence of hip dislocation following hip replacement surgery depends on patient,
surgical and hip implant factors. In general, the larger the head of the femur post
surgery, the less likely a patient is to experience dislocation.
 Treatment
 Nonoperative
• emergent closed reduction within 12 hours    
• indications
• acute anterior and posterior dislocations
• contraindications
• ipsilateral displaced or non-displaced femoral neck fracture

• Operative
• open reduction and/or removal of incarcerated fragments
• indications
• irreducible dislocation
• radiographic evidence of incarcerated fragment
• delayed presentation
• non-concentric reduction
• should be performed on urgent basis

• ORIF
• indications
• associated fractures of
• acetabulum
• femoral head
• femoral neck
• should be stabilized prior to reduction

• arthroscopy
• indications
• no current established indications
• potential for removal of intra-articular fragments
• evaluate intra-articular injuries to cartilage, capsule, and labrum
 Complications
• Post-traumatic arthritis
• up to 20% for simple dislocation, markedly increased for complex
dislocation
• Femoral head osteonecrosis
• 5-40% incidence
• Increased risk with increased time to reduction
• Sciatic nerve injury
• 8-20% incidence
• associated with longer time to reduction
• Recurrent dislocations
• less than 2%
thank you for listening