Fact-sheet: Hip dislocation


Updated on 04/18/2018 at 4:13 PM

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Definition

Displacement of the femoral head outside the acetabular cavity.

Clinical features

High-energy trauma (MVA)
Posterior dislocation: lower limb in internal rotation, shortening
Anterior dislocation: lower limb in external rotation

Radiography

Posterior dislocations (75%):

  • Iliac (superior/head projected over the iliac bone) (50%),
  • Ischiatic (inferior/head projected over the ischium) (25%)

Anterior dislocations (25%):

  • Pubic (superior/head projected over the pubis) (10%),
  • Obturator (inferior/head projected over the obturator foramen) (15%)

Search for complications:

  • Posterior wall acetabular fracture
  • Partial femoral head fracture
  • Risk of secondary femoral head osteonecrosis

CT

Assessment of complications:

  • Fracture of the posterior wall of the acetabulum
  • Impaction fracture of the femoral head, or cartilage injury during dislocation
  • Risk of secondary osteonecrosis of the head
  • Compression of the sciatic nerve trunk by the head
  • Arterial injury

Management

Emergency reduction under general anesthesia.
If associated fracture: emergency surgical reduction first, followed by treatment of the fracture

Classification

Five types of dislocation have been defined by Levin, whether posterior or anterior.

  • Type I: pure dislocation without instability, with concentric reduction.
  • Type II: irreducible dislocation without fracture of the head or acetabulum.
  • Type III: hip unstable after reduction, or with incarceration.
  • Type IV: associated with an acetabular fracture.
  • Type V: associated with a fracture of the head or neck.