A dislocation of the hip is usually painful and the affected individual is not able to move the leg. In the case of a posterior dislocation, the affected limb may appear shorter and bend inward, whereas an anterior dislocation will cause it to bend outward. When an injury to the associated nerve occurs, the side of the foot or ankle may be numb [10].

• Surgical Procedure

  Rotational acetabular osteotomy could be an effective surgical procedure for reconstruction of the acetabulum by posterolateral rotation of the osteotomized acetabulum. [ncbi.nlm.nih.gov]

  A surgical procedure known as “closed reduction” puts the hip back in place manually, followed by a “spica cast” to hold the hip in place. The cast remains on the hip until the hip returns to normal placement. [intermountainhealthcare.org]

  He has special interest in less invasive surgical procedures, such as knee and shoulder arthroscopy. He has also been consecutively honored as one of America’s top orthopedists in 2009 and 2010. [utahorthopediccenters.com]

  This procedure can be performed under general anesthesia, spinal anesthesia, or through conscious sedation with muscle relaxants Open reduction and internal fixation (ORIF): Open reduction is a surgical procedure to realign the fractured bone, to its [dovemed.com]

• Fatigue

  Here are some of those things: illness or disease (such as HIV or other diseases of the immune system) fatigue or exhaustion stress or anxiety poor nutrition chemotherapy or radiation therapy certain medicines that suppress your immune system, such as [aao.org]

  People with pulmonary MAC infections may experience cough, weight loss, fever, fatigue, and night sweats.[2] Symptoms of disseminated MAC infection include: [1][4] Fever Sweating Weight loss Fatigue Diarrhea Shortness of breath Abdominal pain Anemia People [rarediseases.info.nih.gov]

  For many people with the herpes virus, which can go through periods of being dormant, attacks (or outbreaks) can be brought on by the following conditions: General illness (from mild illnesses to serious conditions) Fatigue Physical or emotional stress [webmd.com]

• Crying

  It is an ideal that is a far cry from the Maria Clara satirically described by Rizal but taken as a model by several generation of Filipinos both men and women, who took him too literally. [remembering-lorenabarros.blogspot.com]

• Trisomy 21

  Introduction Down syndrome (DS) or Trisomy 21 is one of the most common non-lethal chromosomal disorders with an incidence of one in 795 live births. [online.boneandjoint.org.uk]

• Excoriation

  […] but eventually cloud, rupture, crust, and involute After vesicular involution, slow resolution of the remaining erythematous plaques, typically without visible sequelae Scarring can occur if deeper epidermal and dermal layers have been compromised by excoriation [emedicine.medscape.com]

• Hip Dislocation

  Also, Steward and Milford classified hip dislocation based on the stability of functional hip: Type 1: Hip dislocation with features of no or insignificant fracture. Most cases of the posterior hip dislocations are usually in type 1 group. [symptoma.com]

  Keywords Anterior hip dislocation; Open reduction; Hip joint Introduction Traumatic hip dislocation in children is rare, only 5% of all hip dislocations occur under 14 years of age [ 1 ]. [bone.imedpub.com]

  A violent force is usually required to dislocate an adult's hip but children may sustain a hip dislocation following relatively minor trauma. Most adult hip dislocations are caused by motor vehicle accidents or significant falls from height. [patient.info]

  […] in this case but significant soft tissue injury is likely Hip dislocation - Dislocated THR Hover on/off image to show/hide findings Tap on/off image to show/hide findings Click image to align with top of page Hip dislocation - Dislocated THR Patient [radiologymasterclass.co.uk]

• Fracture

  Review Article Abstract Author Information Authors A simple hip dislocation is one without fracture of the proximal femur or acetabulum. Complex fracture-dislocations involve the acetabulum, femoral head, or femoral neck. [journals.lww.com]

  A good outcome was seen in 13 patients, 3 with type 1 fracture, 9 with type 2 fracture and 1 with type 3 fracture. Eight patients, 3 with type 2 fracture and 5 with type 3 fracture, had a fair outcome. [ncbi.nlm.nih.gov]

  Type 4: Hip dislocation involving acetabular floor fracture. Type 5: Involves femoral head fracture. [symptoma.com]

• Hip Pain

  Symptoms of Hip Joint Dislocation Hip Pain - Severe intractable hip pain is felt immediately following hip dislocation. Pain is increased with activities. Inability to Move Leg - Patient is unable to move the injured limb. [epainassist.com]

  Author information 1 Center for Hip Pain and Preservation, Hospital for Special Surgery, New York, NY. [ncbi.nlm.nih.gov]

  On this page: Pain at the front of the hip (anterior hip pain) Pain on the outside of the hip (lateral hip pain) Pain at the front of the hip Labral tear A labral tear of the hip joint is a tear to the cartilage lining of the hip joint, called the acetabulumm [sportsinjuryclinic.net]

• Joint Dislocation

  Hip pain is extremely severe following hip joint dislocation or hip dislocation. Traumatic injury involving hip joint often causes dislocation of the hip joint. [epainassist.com]

  A case report of a bilateral asymmetrical hip joint dislocation with bilateral acetabular fracture in a 28-year-old man is presented. [ncbi.nlm.nih.gov]

  […] of hip joint, Coxofemoral luxation, Hip joint--Dislocation, Dislocation of Hip Joint, dislocation; hip, hip; dislocation, Dislocation of hip joint, Dislocation of hip joint (disorder), dislocation of the hip Dutch heupontwrichting, ontwrichte heup, heup [fpnotebook.com]

  Complications Complications of a joint dislocation can include: Tearing of the muscles, ligaments and tendons that reinforce the injured joint Nerve or blood vessel damage in or around your joint Susceptibility to reinjury if you have a severe dislocation [mayoclinic.org]

• Thigh Pain

  Some standard symptoms include: Numbness in the legs and thighs Limited mobility in legs and thighs Pain or tingling sensation when moving legs Swelling or bruises Deformed shape around the pelvis When determining if the hip dislocation is anterior or [runnerclick.com]

• Neuralgia

  Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study. Pain. 1999;80:533–538. [PubMed] [Google Scholar] 26. Rice AS, Maton S Postherpetic Neuralgia Study Group. [ncbi.nlm.nih.gov]

  Post-herpetic neuralgia Post-herpetic neuralgia is defined as persistence or recurrence of pain in the same area, more than a month after the onset of herpes zoster. [dermnetnz.org]

  Post-herpetic neuralgia can be treated with topical painkillers such as lignocaine gel or capsaicin or simple analgesics such as paracetamol. In severe, persistent post-herpetic neuralgia, tricyclic antidepressants can be used to relieve the pain. [healthhub.sg]

  The pain of postherpetic neuralgia may be sharp and intermittent or constant and may be debilitating. [merckmanuals.com]

  Acyclovir for treatment of postherpetic neuralgia: efficacy and pharmacokinetics. Antimicrob Agents Chemother. 2001 Oct. 45(10):2771-4. [Medline]. [Full Text]. Dworkin RH, Schmader KE. Treatment and prevention of postherpetic neuralgia. [emedicine.medscape.com]

• Sciatica

  When the hip is dislocated, bones may be broken, and nerves, including the sciatic nerve (see Sciatica), may be injured. The blood supply to the head of the thighbone may be disrupted, causing bone tissue to die (called osteonecrosis). [msdmanuals.com]

  Symptoms of a Hip Dislocation Severe pain in the hip area that worsens when you try to move your hip Referred pain may be felt in the knee if the IT band is damaged Lower back or sciatica pain if the sciatic nerve is pinched Difficulty walking, standing [mendmyhip.com]

  […] lasting 1-10 days (average, 48 hours) Phenomena usually are noted as pain or, less commonly, itching or paresthesias [3] Pain may simulate headache, iritis, pleurisy, brachial neuritis, cardiac pain, appendicitis or other intra-abdominal disease, or sciatica [emedicine.medscape.com]

• Vertigo

  Ear pain, facial paralysis, and sometimes vertigo occur. Vesicles erupt in the external auditory canal, and taste may be lost in the anterior two thirds of the tongue. [merckmanuals.com]

  Also, rarely, shingles can spread to the nerves in the inner ear, which can lead to hearing loss, vertigo and loss of balance. It can take up to six weeks for shingles pain to disappear. [poz.com]

  The patient may experience hearing impairment, nystagmus, vertigo, or a facial nerve palsy mimicking Bell palsy. [18] Patients may lose taste sensation in the anterior two thirds of the tongue. [18] Clinical phases of disease The clinical manifestations [emedicine.medscape.com]

Hip dislocations can be diagnosed using different imaging techniques which include X-rays, computed tomography scan (CT), and magnetic resonance imaging (MRI).

An x-ray examination of the anteroposterior (AP), lateral side, including both internal and external oblique imaging of the femur assists in diagnosing the condition [11]. A complete X-ray evaluation of the affected hip is required in other to determine the extent and type of the dislocation. The anteroposterior view of the pelvis may reveal the size and appearance of the femoral head. In addition, the positioning of the femoral head in association with the acetabulum is assessed to determine whether surgery is required. Fractures of the acetabulum, femoral head or neck are better evaluated with lateral and oblique views. During hip dislocation management, post-reduction x-rays are important in order to evaluate the progress of the bone attachment (which is referred to as reduction process) and to identify loose bone fragments or fractures that may interfere with the completion of the reduction process or cause post-reduction complications.

Another technique for diagnosing a hip dislocation is the CT scan [12]. The choice of CT scan technique in the workup of hip dislocation is controversial, however, cases with closed reduction failure or an asymmetric joint space may necessitate the use of the technique. A CT scan assists in diagnosing loose bodies such as damaged soft tissues and fragments that can impair closed reduction; it is also useful to evaluate acetabular fractures.

Hip dislocation may also be diagnosed by magnetic resonance imaging. This technique is recommended in an acute hip dislocation with associated conditions, such as labral tears or cartilaginous loose bodies. Osteonecrosis which develops as a complication of the dislocation may also be diagnosed using an MRI after 4-6 weeks and is subsequently repeated after 3 months.

Generally, patients with hip dislocation are managed based on the diagnosis. In cases where there are no other damages or injuries to the hips, the femoral head is adjusted into the pelvis quickly (a process that is referred to as reduction) [8]. The delay in this process may result in avascular necrosis or osteonecrosis. Surgery may not be required. Patients may be given local or general anesthesia before the reduction process. Also, sedatives and muscle relaxants may be indicated, in other to allow for proper manipulation of the femur by the clinicians [13]. Hip joint reduction is usually done with the patient lying on a flat, rigid board facing up, and the hip is gently flexed, while the femur is pulled upwards. In cases of injury damage to the femoral head, nerves, acetabulum, as well as the presence of loose bone fragments at the hip joint, which may slow the reduction process, surgery may be indicated.

Patients with a posterior hip dislocation may be able to walk after 5-7 days following reduction. Some patients with severe cases may permanently require mobile aid to walk. After reduction, patients are not encouraged to engage in continuous bed rest, since it can increase chances of complications such as the formation of blood clots. Following surgery, physiotherapy activities such as passive exercise are employed to exercise the hip joint either manually or with the aid of a continuous passive motion machine.

The prognosis of hip dislocation depends on the nature and extent of the damage to the hip joint. The prognosis of anterior dislocations of the femoral head which do not include a fracture or injury is better than the prognosis of cases that affect the posterior end. Other factors such as osteonecrosis, arthritis, duration until resolution and injury severity play a major role in the determination of the outcome [9]. However, the reduction timing during treatment is considered to be the most important factor in the prognosis of the hip dislocation.

Following a hip dislocation, osteonecrosis may develop on the femoral head, which may result in a poor outcome. Previous studies reported an incidence rate of 4.8% and 52.9% in osteonecrosis development arising from the hip reduction before or after 6 hours of injury respectively. Symptoms of osteonecrosis arise most frequently within 2 years after the injury; sometimes, osteonecrosis may be observed as late as 5 years following the initial injury. Therefore, a proper management of patients with hip dislocation alongside imaging techniques in other to prevent osteonecrosis are important [9].

Arthritis may develop after hip dislocation, and it is the most common complication of the condition. This complication affects the prognostic outcome negatively. In addition, the sciatic nerve may also be affected due to the fracture or dislocation of the hip. In cases where nerve function is impaired after resolution, an examination is necessary [9].

Most dislocations involving the hip joint cause the head of the femur to be posteriorly shifted. The dislocations usually result from the flexing of both knee and the hip joint with pressure exerted to the knee. A hip dislocation may result from hitting the knee against a surface such as a car dashboard in a road traffic accident. Hip dislocations may also result from falls from a high altitude, such as during ladder climbing or through high-impact sports like wrestling, rugby, football and karate [3]. Most often, the traumatic force which causes dislocation of the hip joint may also affect other body parts. The accident may simultaneously damage or dislocate the knee, arm, or legs of the affected individual. Sometimes, the neck or head may also be fractured. Children may be affected by a congenital dislocated hip bone, referred to as hip dysplasia [4]. Undetected hip dysplasia may cause failure of the hip to develop normally.

In a dislocated hip, damage to the bones and to the related nerves, such as the sciatic nerve, may co-exist. Also, blood supply to the femoral head may be impaired, resulting into osteonecrosis.

Hip dislocations commonly occur among adults and rarely among young individuals. About 5% of the cases are observed in patients below the age of 14 years and mostly affect males, due to injury resulting from low-energy sporting games or falls [5]. Only a few reports are available about the prevalence of hip dislocation among athletes and most cases (70%) result from road traffic accidents. Hip dislocations are commonly reported in sporting activities such as American football and rugby. In football, 3% of major injuries involve either a hip fracture or dislocation. Sports which include rugby, alpine skiing and snowboarding constitute the second most prevalent cause of hip dislocations [2].

Previous studies involving skiers and snowboarders reported a higher incidence of hip dislocation with or without a fracture among snowboarders when compared to skiers over a period of time [6]. Also, cases of hip dislocations and fractures among drivers and equestrians have been reported [7].

Anatomically, the hip joint is a ball and socket type of joint, which is usually stable and allows for proper movement. Therefore, a dislocation of the hip joint occurs rarely. The disorder arises due to the effect of high pressure on the hip bone, particularly the femoral head; a fracture of the posterior acetabular wall can accompany the dislocation. Sometimes, the neck of the femur and the articular cartilage of the femur may be involved. Injuries causing bone or cartilage fragmentation may cause a deposition of comminuted bodies or particles at the hip joint [8].

There is no medical literature about preventing the occurrence of hip dislocation, however, individuals are encouraged to be cautious and avoid any possible injuries or accidents which can result in the condition. High-risk individuals, particularly athletes of physically demanding games are trained, guided, and advised to wear protective materials to avoid hip dislocation.

Some anatomical joints of the body such as the wrist, shoulder or ankle joint are prone to dislocation following accidental events. However, hip joint dislocation is relatively rare and is usually caused by accidents resulting from sports, road traffic accidnts and other physical activities [1]. Severe traumatic conditions which are referred to as large-force traumas from accidents are usually the main factor causing hip dislocation [1]. The traumatic conditions arise from a high-energy impact and may cause injury or dislocation of the hip. Sporting activities with increased risk for hip dislocation include American football, rugby, gymnastics (such as vaults, acrobatics, floor exercise, etc.), running, basketball, car race, equestrian sports (horse riding, polo, horse racing, etc.) and water and alpine skiing (snowboarding) [2].

The dislocation of the femoral bone may either be anterior or posterior. The posterior type of hip dislocation is the most common form in traumatic dislocations. The posterior hip dislocation is classified into different groups depending on the damaging effect of the injury on the bone.

Based on the radiographic features, Thompson-Epstein classified hip dislocation into:

• Type 1: Hip dislocation with or without features of minor fracture.
• Type 2: Hip dislocation with features of large, single fracture of posterior rim of the acetabulum.
• Type 3: Hip dislocation in which the rim of acetabulum is fragmented, with or without major fragments.
• Type 4: Hip dislocation involving acetabular floor fracture.
• Type 5: Involves femoral head fracture.

Also, Steward and Milford classified hip dislocation based on the stability of functional hip:

• Type 1: Hip dislocation with features of no or insignificant fracture. Most cases of the posterior hip dislocations are usually in type 1 group.
• Type 2: Hip dislocation associated with a single or fragmented posterior rim, but the hip still remains stable in a functional range of motion or movement.
• Type 3: The dislocated hib results in gross instability of the hip joint, which is secondary to loss of physical support.
• Type 4: Occurs with femoral head fracture.

Due to the morbidity and severe effect on the physical posture, which are commonly associated with hip dislocations, a proper management of the condition is very important. Prompt and proper treatment is necessary in other to prevent chronic sequelae such as avascular necrosis.

Hip dislocation results from the separation of the thighbone (femur) head from the pelvic bone (pelvis) socket. It is an uncommon condition and it is caused by severe injury. High-impact injuries resulting from accidents, which affect the hip joint, may result in the dislocation of the hip. The accident can be due to high-altitude falls, road traffic accidents or sporting activities including high-energy sports such as American football, rugby, football, skiing, and snowboarding.

Major symptoms of hip dislocation include severe pain of the affected leg, as patients are unable to move the leg. Injury that affects the associated sciatic nerve, may result in numbness or pain at the joint. Hip dislocations are diagnosed by the clinician after the previous history of the patient has been taken, including the nature of the injury that caused the condition. Various clinical investigations may be requested to evaluate the state of the dislocation. These investigations include x-rays, magnetic resonance imaging (MRI) and computed tomography (CT) scan. Clinical treatment in which the dislocated hip is re-joined or manipulated into the normal position is called reduction. The clinician may administer anesthesia or sedatives during treatment and may non-surgically manipulate the hip bones to the normal state. However, surgery may be required if there are complications due to bone fragments or loose bodies that can impair reduction process.

1. Mitchell JC, Giannoudis PV, Millner PA, Smith RM. A rare fracture-dislocation of the hip in a gymnast and review of the literature. Br J Sports Med. 1999; 33(4):283-4.
2. Pallia CS, Scott RE, Chao DJ. Traumatic hip dislocation in athletes. Curr Sports Med Rep. 2002; 1(6):338-45.
3. Tennent TD, Chambler AF, Rossouw DJ. Posterior dislocation of the hip while playing basketball. Br J Sports Med. 1998; 32(4):342-3.
4. Sewell MD, Rosendahl K, Eastwood DM. Developmental dysplasia of the hip. BMJ. 2009; 339: b4454.
5. Kovacevic D, Mariscalco M, Goodwin RC. Injuries about the hip in the adolescent athlete. Sports Med Arthrosc. 2011; 19(1):64-74.
6. Matsumoto K, Sumi H, Sumi Y, Shimizu K. An analysis of hip dislocations among snowboarders and skiers: a 10-year prospective study from 1992 to 2002. J Trauma. 2003; 55(5):946-8.
7. Rancan M, Esser MP, Kossmann T. Irreducible traumatic obturator hip dislocation with subcapital indentation fracture of the femoral neck: a case report. J Trauma. 2007; 62(6):E4-6
8. Sanders S, Tejwani N, Egol KA. Traumatic hip dislocation - a review. Bull NYU Hosp Jt Dis. 2010; 68:91-96.
9. Hougaard K, Thomsen PB. Traumatic posterior dislocation of the hip - prognostic factors influencing the incidence of avascular necrosis of the femoral head. Arch Orthop Trauma Surg. 1986;106:32-35.
10. Hillyard RF, Fox J. Sciatic nerve injuries associated with traumatic posterior hip dislocations. Am J Emerg Med. 2003; 21(7):545-8.
11. Soto JA, Lucey B. Emergency Radiology: The Requisites. Mosby. ISBN:0323054072.
12. Seltzer SE, Weissman BN, Braunstein EM, et al. Indications for CT scanning in orthopedic disorders of hip. Orthop Rev. 1983. 12:29-40.
13. Stewart MJ, Milford LW. Fracture-dislocation of the hip; an end-result study. J Bone Joint Surg Am. 1954; 36:315-342.