HIP DISLOCATION |
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General Information
DEFINITION--A serious hip injury in which adjoining bones in the hip are displaced so they no longer touch each other. Dislocations are frequently accompanied by bone fractures, torn ligaments and torn tendons. Temporary or permanent damage to bone or to the sciatic nerve makes immediate treatment necessary.
BODY PARTS INVOLVED
Femur (thigh bone) and pelvis.
Strong ligaments that hold the hip in place.
Sciatic nerve.
Soft tissue surrounding the dislocated hip, including periosteum (covering to bone), other nerves, tendons, blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Severe pain in the hip at the time of injury, and when trying to move hip.
Loss of hip function.
Visible deformity if the dislocated bones have locked in the dislocated position. The leg may appear shortened and turned in. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
Tenderness over the dislocation.
Swelling and bruising at the injury site.
Numbness or paralysis below the dislocation from pressure, pinching or cutting of blood vessels or nerves.
CAUSES
Direct or indirect blow to a flexed knee and hip.
End result of a severe hip sprain.
Congenital abnormality, such as shallow or malformed joint surfaces.
RISK INCREASES WITH
Contact sports, especially football and hockey.
Previous hip dislocation or sprain.
Repeated hip injury of any type.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning.
HOW TO PREVENT
Build your overall strength and muscle tone with a long-term conditioning program appropriate for your sport.
Warm up adequately before physical activity.
After healing, protect vulnerable joints with special hip pads.
Consider avoiding contact sports if treatment is unsuccessful in restoring a strong, stable hip.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment.
Surgery (sometimes) to restore the joint to its normal position and repair torn ligaments and tendons. Acute or recurring dislocations may require surgical reconstruction or replacement of the joint.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the hip, pelvis and knee.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels and connective tissue.
AFTER TREATMENT OR SURGERY:
Excessive internal bleeding.
Impaired blood supply to the dislocated area.
Death of bone cells due to interruption of the blood supply.
Infection introduced during surgical treatment.
Aseptic necrosis (death of tissue without infection) of the head of the femur.
Prolonged healing if activity is resumed too soon.
Repeated hip dislocations.
Unstable or arthritic hip after repeated injury.
PROBABLE OUTCOMEAfter the dislocation has been corrected, the joint may require immobilization for 4 to 6 weeks in a body cast that encloses the hip. Complete healing of injured ligaments requires a minimum of 6 weeks. Allow at least 3 months of healing before resuming active participation in sports.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Support the injured area with pillows during movement or transportation.
The doctor will manipulate the hip bones to return them to their normal position. Manipulation should be done as soon as possible after injury. Shortly after a hip dislocation, bleeding in the hip area and displacement of body fluids may lead to shock and other major problems. Also, many tissues lose their elasticity and become difficult to return to a normal position within 4 to 6 hours after dislocation.
CONTINUING CAREAt home:
Apply heat frequently. Use heat lamps, hot soaks, hot showers or heating pads.
Take whirlpool treatments, if available.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
General anesthesia or muscle relaxants to make joint manipulation possible.
Acetaminophen to relieve moderate pain.
Narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to decreased activity.
Antibiotics to fight infection if surgery is required.
ACTIVITY
Walk only with crutches until after the cast is removed and you can safely bear weight. See Appendix 3 (Safe Use of Crutches).
Begin weight-bearing and reconditioning of the hip and leg after clearance from your doctor.
If surgery is necessary, resume normal activities and reconditioning gradually. Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
Eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises when pain subsides.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a hip dislocation. Call immediately if the leg becomes numb, pale, or cold after injury. This is an emergency!
Any of the following occurs after treatment:
Swelling above or below the cast.
Blue or gray skin color beyond the cast, particularly under the toenails.
Loss of feeling below the hip.
Nausea or vomiting.
Constipation.
Any of the following occur after surgery:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
Hip dislocations that you can "pop" back into normal position occur repeatedly.
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