HIP DISLOCATIONS

Dislocations of the hip joint result from high-energy trauma and are associated with injuries of the acetabulum, femoral shaft and patella. Posterior dislocations are most common.

Evaluation

Make the diagnosis from the history of the injury and the physical findings of a flexed, adducted, internally rotated hip that is painful to move. The clinical examination is sufficient to make the diagnosis, but X-rays are necessary to identify associated fractures.

Examine the sciatic nerve function by testing foot and ankle strength and sensation.

Treatment

::	1 Reduce the dislocation as soon as possible: • With the patient supine, apply traction to the flexed hip while an assistant holds the pelvis down for counter traction (Figure 18.47); muscle relaxation is usually necessary • If you have no assistant, use an alternative method with the patient prone: – Apply traction downward with the leg flexed over the edge of the table – Gently rotate the hip while applying pressure on the femoral head in the gluteal region (Figure 18.48).
Figure 18.47
Figure 18.48
::	2 Place the patient in post-reduction skin traction for a few days and then begin non-weight bearing ambulation with crutches. Allow weight bearing after 12 weeks. If there is a large posterior rim fracture, treat the patient in traction for 8–12 weeks while the fracture unites.