What is the diagnosis and management of suspected hip dislocation?

From the Guidelines

Hip dislocation is a medical emergency that requires immediate diagnosis and treatment, and while creases in hips are not a reliable diagnostic tool, prompt radiographic confirmation with anteroposterior and lateral hip X-rays is essential for diagnosis and management. When a hip dislocation is suspected based on symptoms like severe hip pain, leg shortening, internal rotation, and inability to bear weight, management begins with rapid reduction, ideally within 6 hours to minimize the risk of avascular necrosis of the femoral head, as emphasized by the American College of Radiology in their appropriateness criteria for acute hip pain-suspected fracture 1. Some key points to consider in the diagnosis and management of suspected hip dislocation include:

• Prompt radiographic confirmation with anteroposterior and lateral hip X-rays
• Rapid reduction, ideally within 6 hours, to minimize the risk of avascular necrosis of the femoral head
• Administration of appropriate analgesia and muscle relaxants prior to reduction
• Use of the Allis or Stimson maneuver for closed reduction, performed by an experienced provider
• Post-reduction confirmatory imaging and assessment of neurovascular status
• Protected weight-bearing with crutches or a walker for 6-8 weeks, followed by physical therapy The American College of Radiology also notes that hip fractures, which can be associated with hip dislocation, are a frequent source of morbidity and mortality in elderly osteoporotic patients, and that delays in diagnosis and treatment are associated with increased cost, complication rate, length of hospital stay, and short- and long-term mortality 1. Therefore, it is crucial to prioritize prompt and accurate diagnosis and treatment of hip dislocation to minimize the risk of complications and improve patient outcomes.

From the Research

Diagnosis of Hip Dislocation

• Hip dislocation is a well-described event that occurs in conjunction with high-energy trauma or postoperatively after total hip replacement 2.
• The direction of dislocation matters, with most dislocations being posterior, while anterior dislocation remains rare 3.
• Diagnosis is highly dependent on imaging, both at presentation and after attempted reduction, with plain anteroposterior radiographs of the pelvis showing the dislocation in most patients 4.
• Lateral views or a computed tomography scan may be required to confirm the diagnosis and to show the direction if the signs are subtle 4.

Role of Creases in Hips

• There is no direct evidence in the provided studies that creases in hips aid in identifying hip dislocation.
• However, the studies suggest that imaging features, such as the direction of dislocation, associated fractures, and osteonecrosis, are important in guiding management and preventing complications 2, 5, 4.

Management of Suspected Hip Dislocation

• Closed reduction is the initial treatment method, usually occurring in the emergency room 2.
• Anterior hip dislocation is commonly reduced by inline traction and external rotation, while posterior hip dislocations are reduced by placing longitudinal traction with internal rotation on the hip 2.
• Nonoperative care requires surgeons to understand the indications, while surgical care requires the surgeon to understand the benefits and limitations of several surgical approaches 6.
• Timely evaluation and treatment, including recognizing the potential complications, are necessary to offer the best outcome for the patient 2, 5.