Hip Dislocation Management in the ED Clinical Presentation

Updated: Jan 07, 2022
  • Author: Stephen R McMillan, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Presentation

Physical

As with any victim of major trauma, assessment of airway, breathing, and circulation is of primary importance. During the secondary survey, examination of the pelvic girdle and hip is mandatory. Examination should consist of inspection, palpation, active/passive range of motion, and a neurovascular examination.

Inspection

Isolated anterior dislocation has a classic appearance, as does isolated posterior dislocation. In practice, appearances may be altered by the presence of fracture-dislocation or other bony abnormalities of the leg.

  • Posterior: The hip is flexed, internally rotated, and adducted.

  • Anterior: The hip is minimally flexed, externally rotated, and markedly abducted.

Palpation

Palpate the pelvis and the lower extremity for gross bony deformities or step-offs. With anterior hip dislocation, the femoral head occasionally can be palpated. A large hematoma may signify vascular injury.

Range of motion

Patients with hip dislocation have severely limited range of motion due to pain. Evaluate what the patient can do comfortably. Do not forcefully perform range of motion on a patient who cannot tolerate manipulation. Normal, painless range of motion virtually excludes hip dislocation.

Neurovascular examination

Signs of sciatic nerve injury include loss of sensation in the posterior leg and foot, loss of dorsiflexion (peroneal branch) or plantar flexion (tibial branch), and loss of deep tendon reflexes (DTRs) at the ankle.

Femoral nerve injury may be seen as loss of sensation over the thigh, weakness of the quadriceps, and loss of DTRs at the knee.

The patient with vascular injury may present with hematoma, loss of pulses, and pallor.