Dislocated hips rarely occur during a sports event. Motorcycle accidents are a common cause of hip dislocations. Diagnosing large-force trauma that causes hip dislocation is necessary. There are two types of hip dislocations:
- Anterior hip dislocation
- Posterior hip dislocation
This classification helps in the characterization of posterior hip dislocation. Following are the different types that help in distinguishing the stage of fracture:
- Type 1 – With or without minor fracture
- Type 2 – With the large, singular fracture of the posterior acetabular rim
- Type 3 – With comminution of the rim of the acetabulum, with or without major fragments
- Type 4 – With the fracture of the acetabular floor
- Type 5 – With the fracture of the femoral head
This classification is one of many that help in the correct classification of hip dislocation. Another classification is known as the Steward and Milford Classification that classify hip dislocation based on hip stability.
Epidemiology of Hip Dislocation
American football and rugby reportedly cause more dislocation than any other sports. Alpine skiing and snowboarding are also responsible for many dislocated hips, but most dislocations (>70%) occur due to motor accidents. Mostly old aged persons are susceptible to hip dislocation. It is very rare in young persons.
The coxal bone/ hip bone joint is composed of the femoral head and the acetabulum of the pelvis. The joint is ball-and-socket type. The femur is held by five ligaments that are:
- The iliofemoral ligament
- The pubofemoral ligament
- The ischiofemoral ligament
- The transverse acetabular ligament
- The femoral head ligament
These ligaments held the hips in place, and the dislocation is made difficult because of them. The adjacent shaft of the femur and femoral neck has a great supply of blood.
There are two different ways through which anterior hip dislocation is presented:
- Superiorly displaced dislocations show the hip extended and externally rotated.
- Inferior dislocation present with the hip flexed, abducted, and externally rotated.
- Posterior hip dislocation commonly appears shortened, internally rotated, and abducted.
Surgical intervention should be done if the joint remains unstable or the closed reduction is not successful. If the fragments of bone or tissue remain in joint space, that too calls for surgical intervention. Thorough irrigation of the joint should be done, so no tissue fragment remains in the joint space. Fixation should be done using screws and plates and should be done by the expert surgeon.
An orthopedic surgeon should be consulted for hip dislocations. The first attempt will be a closed reduction. If that is unsuccessful, then an open reduction should be made. The traction method should be used if the patient is awaiting surgical intervention.
Physical therapy should be done after the inflammation has gone so that the hip does not get unstable due to lack of use. Proper rehabilitation is necessary so that normal function should be retained. The use of crutches should be effective immediately after the inflammation has gone done. There is some relief from pain. A 6-week MRI should be done to observe any femoral head ischemia.
Strengthening exercise should be started as soon as the patient is pain-free and ambulatory function resumes. Exercises to strengthen different functions of the hip joint should be done, and the recovery changes from person to person. While one person may start jogging within few months, others might take more time to heal.
Many techniques should be done for the strengthening of hip muscles. Here we will talk about some of them:
These exercise techniques will help in increasing flexibility and range of motion. Self-stretching exercises for flexibility are chosen according to the degree of limitation and ability of the patient.
Increasing Hip Extension
The patient should be prone with hands on the table at shoulder level. The patient should press the thorax upward and relax the pelvic. If this exercise causes the pain to shoot through the patient’s leg, it should not be performed.
Thomas Test Stretch
The patient’s hip should be supine on the end of the table. Knees and hips should be flexed. The thigh on the opposite hip is held against the chest. The patient should stretch the thigh slowly towards the table. Do not allow the thigh to rotate. The weight of the leg should cause the stretch.
Modified Fencer Stretch
The patient should stand in a fencer lunge-like pose. The back leg and front leg should be in the same plane. The foot should point forward. The patient should do a posterior pelvic tilt then shift the weight to the anterior leg until a stretch sensation can be felt. The heel of the back foot on the floor might stretch the gastrocnemius muscle.
Kneeling Fencer Stretch
kneel on one side to be stretched. The other leg should be forward and foot on the ground. The patient should do a posterior body tilt and shift weight on the anterior leg until a stretch can be felt.
Increasing Hip Flexion
Bilateral Knee to Chest Stretch
The patient should be in the supine position. The physiotherapist should assist in this position. Ask the patient to bring the knees to the chest and grasp the thighs firmly until a stretch is felt in the leg. This exercise should be observed closely.
Unilateral Knee to Chest Stretch
This exercise is the same as the previous, but only one knee is used instead of both knees. The position helps in the isolation of stretch force to the hip. To maximizes the stretch, the patient should pull the knee to the opposite shoulder.
The patient should be on his hands and knees. The patient should rock the pelvis into an anterior tilt. This will cause lumber extension, then maintaining the lumber extension shift the buttocks and attempt to sit on heels.
As hip dislocation surgery should be done under the keen eye of expert orthopedic surgeons, the aftercare and rehabilitation should be done by an expert physiotherapist. An expert therapist will increase the recovery time and help maintain the recovery for the long term.