Hip dislocation

A hip dislocation refers to a condition in which the thighbone (femur) separates from the hip bone (pelvis). Specifically it is when the ball–shaped head of the femur (femoral head) separates from its cup–shaped socket in the hip bone, known as the acetabulum. The joint of the femur and pelvis (hip joint) is very stable, secured by both bony and soft-tissue constraints. With that, dislocation would require significant force which typically results from significant trauma such as from a motor vehicle collision or from a fall from elevation. Hip dislocations can also occur following a hip replacement or from a developmental abnormality known as hip dysplasia. Hip dislocations are classified by fracture association and by the positioning of the dislocated femoral head. A posteriorly positioned head is the most common dislocation type. Hip dislocations are a medical emergency, requiring prompt placement of the femoral head back into the acetabulum (reduction). This reduction of the femoral head back into the hip socket is typically done under sedation and without surgery, through maneuvers including traction on the thighbone in line with the dislocation. If this is unsuccessful or if there is an associated fracture in need of repair, surgery is required.…

A hip dislocation refers to a condition in which the thighbone (femur) separates from the hip bone (pelvis). Specifically it is when the ball–shaped head of the femur (femoral head) separates from its cup–shaped socket in the hip bone, known as the acetabulum. The joint of the femur and pelvis (hip joint) is very stable, secured by both bony and soft-tissue constraints. With that, dislocation would require significant force which typically results from significant trauma such as from a motor vehicle collision or from a fall from elevation. Hip dislocations can also occur following a hip replacement or from a developmental abnormality known as hip dysplasia. Hip dislocations are classified by fracture association and by the positioning of the dislocated femoral head. A posteriorly positioned head is the most common dislocation type. Hip dislocations are a medical emergency, requiring prompt placement of the femoral head back into the acetabulum (reduction). This reduction of the femoral head back into the hip socket is typically done under sedation and without surgery, through maneuvers including traction on the thighbone in line with the dislocation. If this is unsuccessful or if there is an associated fracture in need of repair, surgery is required. It often takes 2–3 months for a dislocated hip to fully heal, and it can take even longer depending on associated injuries such as fracture. Typically, people with hip dislocations present with severe pain and an inability to move the affected leg. Diagnosis is made by physical exam and plain X-rays of the hips. A CT scan is recommended following reduction to rule out complications. Complications include osteonecrosis, femoral head fractures, and posttraumatic osteoarthritis. Males are affected more often than females. Traumatic dislocations occurs most commonly in those 16 to 40 years old. Half of all hip dislocations are accompanied by a fracture. The condition was first described in the medical press in the early 1800s. ===Rehabilitation=== Individuals with hip dislocation should participate in physical therapy and receive professional prescriptive exercises based on their individual abilities, progress, and overall range of motion. The following are some typical recommended exercises used as rehabilitation for hip dislocation. It is important to understand that each individual has different capabilities that can best be assessed by a physical therapist or medical professional, and that these are simply recommendations. ====Exercises==== Bridge- Lie flat on back. Place arms with palms down beside body. Keep feet hip distance apart and bend knees. Slowly lift hips upward. Hold position for three to five seconds. This helps strengthen the glutes and increase stability of the hip joint. Supine leg abduction- Lie flat on back. Slowly slide leg away from body and then back in, keeping the knees straight. This exercises the gluteus medius and helps to maintain stability in the hip while walking. Side Lying Leg abduction- Lie on one side with one leg on top of the other. Slowly lift the top leg towards the ceiling and then lower it back down slowly. Standing Hip abduction- Standing up and holding on to a nearby surface, slowly lift one leg away from the midline of the body and then lower it back to starting position. This is simply a more advanced way to do any of the lying hip abduction exercises, and should be done as the person progresses in rehab. Knee raises- While standing and holding onto a chair, slowly lift one leg off the ground and bring it closer to the body while bending the knee. Then lower the leg back down slowly. This helps to strengthen the hip flexor muscles and retain stability in the hip. Hip flexion and extensions- Standing, hold on to a nearby chair or surface. Swing one leg forwards away from you, and hold the position for three to five seconds. Then swing the leg slowly backwards and behind your body. Hold for three to five seconds. This exercise helps to increase range of motion, as well as strengthening the hip flexor and hip extensor muscles that control much of the hip joint. Adding ankle weights to any exercises can be done as progress is made in rehabilitation. ==Prognosis== Hip dislocations can take anywhere from 2–3 months to fully heal, and even longer depending on associated injuries such as fracture. Moreover, the outcome ranges from a fully healthy hip to a painful, arthritic one. With simple posterior dislocations, literature reports great outcomes in 70%-80% of cases. With complex dislocations, the outcome is often governed by the associated fracture. Anterior dislocations are noted to have worse outcomes with their higher likelihood of being associated with femoral head injuries. Those without associated femoral head injuries do better. Complications of hip dislocation that impact prognosis include post-traumatic arthritis, femoral head osteonecrosis, femoral head fracture, neurovascular injury, and recurrent dislocation. Post-traumatic arthritis is the most common long-term complication and happens in 20% of hip dislocations, having higher rates among complex dislocations. Femoral head osteonecrosis happens in 5-40% of dislocations, with rates rising the longer time to reduction (>6 hours). Similarly increasing in rates with time to reduction, neurovascular injury with most notable being sciatic nerve injury, occurs in 8-20% of cases. Femoral head fractures accompany 10% of posterior dislocations and 25-75% of anterior dislocations. Lastly, recurrent dislocations can also occur, however is rare (<2%). ==Epidemiology== Males are affected more often than females. Most common cause is high energy trauma such as from a motor vehicle collision or a high-level fall. Traumatic dislocations occur most commonly in those 16 to 40 years old. Of note, restrained passengers are at a lower risk for a hip dislocation than those unrestrained. With the hip being inherently stable, dislocations are rare, however have high rates of associated injuries. For example, half of all hip dislocations are accompanied by a fracture. Refer to "Prognosis and Complications" section for rates of other associated injuries. The condition was first described in the medical press in the early 1800s. ==Other animals==

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