302 Orthopaedic Emergencies
Thoracic and Lumbar Spine Injuries
See page 245.Pelvic Injuries
See page 241.Injuries to the Hip and Upper Femur
Dislocation of the hip
DIAGNOSIS
1 Dislocation of the hip occurs in violent trauma such as a traffic crash, a fall
from a height or sometimes a direct fall on to the hip.
2 The hip joint is inherently stable so always look for associated injuries, as
considerable force is required to produce dislocation.
3 The most common direction to dislocate is posteriorly (85%), such as when
the knee strikes the dashboard of a car.
(i) Other associated injuries from this particular incident are a
fractured femoral shaft and a fractured patella.
4 Less common are the central dislocation, fracturing through the acetabu-
lum, or the rare anterior dislocation.
5 Note on examining a posterior dislocation that the hip is held slightly f lexed,
adducted and internally rotated; whereas in an anterior dislocation the hip is
abducted and externally rotated.
6 Check for sciatic nerve damage in posterior dislocation of the hip, particu-
larly if an acetabular rim fracture is present.
(i) Assess dorsiflexion (L5) and plantar flexion (S1) of the ankle, and
sensation over the medial side of the ankle (L5) and the lateral
border of the foot (S1).
7 Gain i.v. access and send blood for full blood count (FBC), urea and electro-
lytes (U&Es), blood sugar and group and save (G&S).
8 X-ray the pelvis, hip and the shaft of the femur in all cases.
9 Complications are more common with a posterior dislocation and include:
(i) Avascular necrosis of the head of the femur.