Symptoms and reduction of hip dislocation. Traumatic hip dislocation: symptoms, treatment and rehabilitation Describe hip bone dislocation in humans

Hip dislocation is uncommon: 1 in 20 total dislocations. When the head is dislocated hip joint moves and extends beyond the acetabulum of the pelvic bone. The hip joint is the largest joint in our body, performing such important functions like walking, running, standing upright. Therefore, it is fixed by powerful ligaments and protected by large muscles.

Causes

Dislocation of the hip joint can be congenital, due to improper development of the joint in the prenatal period, or acquired. Acquired dislocations usually occur in adults as a result of trauma (car accident or fall from high altitude). As a result of strong indirect mechanical impact, the femur acts as a lever. The head of the bone displaces, breaks the joint capsule and leaves the joint capsule.

Classification

Depending on the direction in which the femoral head was displaced, the following dislocations are distinguished:

• Anterosuperior.
• Anteroinferior.
• Posterior superior.
• Posterior inferior.

Posterior dislocations are five times more common than anterior ones. They occur when the leg is bent. The cause is usually a traffic accident. Anterior dislocations occur when force is applied to a straight leg. As a rule, this happens when falling from a great height. According to the statute of limitations, dislocations are: fresh (up to 3 days), stale (from 3 days to 3 weeks), old (over 3 weeks).

Signs

Whatever the traumatic dislocation, it is characterized by the following symptoms: strong pain in the area of ​​the injured joint, the inability to actively move the joint. An attempt at passive movements leads to increased pain and the appearance of springy resistance. Swelling may occur in the area of ​​injury (groin, buttock). The leg takes a forced position. Depending on the type of dislocation, the victim’s hip can take different positions.

With a posterior dislocation of the leg:

• Bent.
• Presented.
• Turned inward.
• The injured leg is shorter.
• In the gluteal region there is a bulging, and in the inguinal region there is a retraction.

For anterior dislocation:

• The knee is turned outward.
• The hip is slightly abducted.
• The injured leg is longer.
• The displaced head of the femur forms a bulge in the groin, and the buttock becomes flattened.

With old dislocation, all symptoms are less pronounced. The patient even adapts to walking. This occurs due to a displacement of the axis of gravity due to a skewing of the pelvis and curvature of the spine.

First aid

A dislocated hip requires immediate medical attention. Therefore, if you suspect this type of injury, you must immediately call an ambulance. Before doctors arrive, the following measures must be taken:

• Apply cold to the projection of the damaged joint for 15–20 minutes to reduce swelling of the soft tissues.
• This injury is accompanied by severe pain, so it is important to relieve pain. To do this, if possible, give an injection of an analgesic intramuscularly or give a tablet.
• The victim's leg must be fixed (immobilized) in the position in which it is located. If there are no specialized tires, then you can use improvised materials - boards, sticks and the like. Fixation is also carried out using improvised means - any fabric or clothing.

An ambulance team transports the victim to the hospital.

Under no circumstances should you try to straighten a dislocation yourself. You can damage ligaments and tendons and make the situation worse. In extreme cases, when it is not possible to call an ambulance, you can deliver the injured person yourself. To do this, place it on a hard surface (plywood or doors) to avoid additional damage.

Complications of hip dislocation

The following conditions are considered serious complications:

• Avascular necrosis. This is the most dangerous and at the same time quite common complication. It occurs when the vessels supplying the head of the femur are damaged. Without receiving nutrition, tissues die. The only treatment method in this case is endoprosthetics.
• Sciatic nerve contusion. With this complication, pain appears on the back of the leg and impaired skin sensitivity. If during an injury the nerve is torn or completely severed, then complete paralysis of the limb is possible.
• Skin disorders. Skin that does not receive nutrition becomes dry and flaky. Over time, trophic ulcers may appear.
• Obturator nerve injury. This nerve is responsible for the inner thigh muscles. When he is injured, the work of these muscles is disrupted.

Diagnostics

The diagnosis is made on the basis of characteristic complaints, examination data, and an X-ray examination in two projections is required. This allows you to more accurately determine the location of the displaced femoral head, as well as exclude a fracture of the femoral neck. According to indications, magnetic resonance imaging (MRI) is performed. This diagnostic method allows you to most accurately determine the condition of not only bones and ligaments, but vascular and nerve bundles. If the head of the bone moves but does not leave the joint cavity, then hip subluxation is diagnosed.

Treatment

Reduction of a dislocated hip is performed by a traumatologist in a hospital setting. Treatment can be carried out surgically or conservatively. If the hip dislocation is fresh and there are no complications, then treatment is carried out using a conservative method. The victim is given general anesthesia and given muscle relaxants (drugs that relax muscles). Next, the doctor uses one of the methods to realign the joint.

Kocher reduction

The patient’s pelvic bones are fixed and the traumatologist bends the leg at the knee and hip at a right angle. After this, he lifts the limb up and at the same time turns inward. If the head of the joint is in place, a characteristic loud click is heard.

After the anesthesia wears off, the victim is placed face down on the operating table. In this case, the injured leg hangs freely to the side. Two bags of sand are placed under the patient’s pelvis, and the traumatologist’s assistant presses on the sacrum to fix the pelvis. The doctor bends the injured leg at the knee joint. In this case, the doctor places his knee in the patient’s popliteal fossa and applies pressure while simultaneously turning the injured leg outward. When the joint is straightened, a characteristic click is heard.

After reduction, control x-rays are taken. If all manipulations are carried out successfully, then the patient is placed in a plaster cast with fixation of all three joints of the limb - hip, knee and ankle. The patient must remain in bed for three weeks. Sometimes skeletal traction is necessary after reduction. To do this, a metal rod is inserted through the tibia, a bracket is attached to it, and a weight is suspended for 3–4 weeks.

Surgery

Such treatment may be necessary for long-standing dislocations or when it is impossible to straighten the hip conservatively. This happens when ligaments are torn, as well as if a joint capsule or other tissue gets into the cavity of the joint capsule. Under general anesthesia During the operation, the doctor removes the tissue trapped in the joint, reduces the dislocation and stitches the ligaments.

Rehabilitation

For injured adults, rehabilitation is at least 2 months. It includes exercise therapy, massage and physiotherapeutic procedures. After endoprosthetic surgery rehabilitation period takes about a year.

Physiotherapy

The first light exercises are prescribed at the stage of bed rest. The goal here is to maintain good blood flow to keep muscle atrophy to a minimum. Passive exercises are performed with the help of a physical therapy instructor or nurse. At the second stage, you can perform light active exercises to increase the activity of the joint and prepare it for full load. At the third stage, exercises are performed to strengthen the muscular and ligamentous apparatus of the thigh.

The duration of each stage and the intensity of physical activity are determined by a rehabilitation physician, taking into account the characteristics of the injury and the condition of the patient’s body.

Massage

Massage can be done from the first days of rehabilitation, when limb movements are still impossible. Light stroking, kneading, and rubbing the muscles can improve microcirculation in the muscles and reduce swelling. In the future, the massage may be more intense. This helps to quickly restore muscle tone and avoid atrophy.

Physiotherapy

Physiotherapeutic methods are selected individually for each patient. Most often used:

• Magnetotherapy.
• Diadynamic currents.
• Electrophoresis.
• Ultrahigh frequency therapy.

Congenital hip dislocation

Dislocation of the hip joint in newborns is a common pathology; it is diagnosed in 4% of cases. Children vary in severity:

• Hip dysplasia. This initial stage joint disorders. The anatomical surfaces of the joint are little changed, but there are prerequisites for further violations.
• Pre-dislocation of the hip. The joint capsule is tense and the femoral head is excessively mobile.
• Subluxation of the hip joint. It is characterized by incomplete displacement of the head of the bone relative to the acetabulum, the ligaments are highly strained.
• Dislocation. Complete discrepancy between the head of the joint and the glenoid cavity.

Causes

Why this pathology develops has not been reliably clarified. The main reasons contributing to hip dislocation in infants are breech presentation, fetal weight more than 4 kg, severe toxicosis in the mother, hereditary predisposition, birth trauma, premature birth, and infections suffered by the mother during pregnancy.

Symptoms

In newborns and older children, the manifestation of signs of congenital dislocation is different. It is typical for infants:

• When the hips move apart, a characteristic click is heard.
• The gluteal-femoral folds are asymmetrical.
• Shortening of the affected leg.
• Turning the foot outward on the affected limb.
• Limitation of leg abduction when bending.
• The displaced femoral head may be palpable.

If the child is older than one year, then the signs are as follows:

• Lameness on the affected leg.
• The child begins to walk much later.
• When walking, the body tilts towards the healthy limb.
• curvature lumbar region spine.

The diagnosis is made by a pediatric orthopedist based on examination and identification of characteristic clinical signs. An ultrasound of the joint is also performed, and for children over 3 months old, an X-ray examination is performed.

Treatment

If the pathology is detected immediately after birth, then congenital dislocation of the hip joint is treated conservatively. For dysplasia, wide swaddling and therapeutic massage are prescribed. For more severe cases, various orthopedic structures are used to keep the joint in the correct position. The most commonly used stirrups are Pavlik stirrups, Volkov splints, Freik splints, and Vilensky splints.

The more early age treatment is started, the more favorable the prognosis

Each child is individually prescribed a course of exercise therapy to restore the normal configuration of the hip joint, strengthen muscles, and improve blood circulation. Sometimes congenital hip dislocation has to be treated surgically. This is resorted to in the following cases: the impossibility of reduction using a conservative method due to pronounced displacement, the child’s age is over 2 years, pinching of cartilage in the articular cavity, additional anomalies due to which closed reduction is impossible.

After the operation, the child will have a long rehabilitation period – up to 1.5 years. During this time, massage and special exercises are used. The child is taught to walk correctly using a special walkway. In the absence of timely and competent treatment, the following undesirable consequences develop over time:

• Formation of a false joint (neoarthrosis).
• Deformation and atrophy of the joint capsule due to constant pressure.
• Coxarthrosis. In this case, the head of the hip joint must be replaced with an endoprosthesis.

Thus, dislocation of the hip joint in both children and adults is a serious pathology that requires the earliest possible diagnosis and treatment. However, if you apply for it in a timely manner medical care and strict adherence to all instructions, the prognosis for this disease is favorable.

Open bone reduction for hip dislocation

​Front.​

A hip dislocation or fracture is a process of damage to the joints in the human pelvis. According to anatomy, the hip joint is the largest; it serves as a support into which the limbs enter, that is, the legs rest against the pelvis and thus have the ability to both secure and move.

The limbs are directly connected to the pelvis by the neck and head, which enters it and allows the legs to move. The neck, the connecting part, is the thinnest, and therefore its damage is most frequent and leads to the worst consequences.

There is a congenital dislocation of the hip joint - the result of a child’s developmental pathology. Such cases are described by the diagnosis “hip dysplasia.” When a joint dislocates, the hip rotates inward or outward.

Central hip dislocation occurs when the head of the bone is displaced towards the pelvic cavity and the glenoid cavity is fractured. With such an injury, the limb is shortened and joint stiffness appears.

Causes

As a rule, disorders are the result of an indirect injury, when the impact is on the femur, and not the joint itself. Moreover, it must be so strong and fast that the head can break through the joint capsule and come out of the glenoid cavity, further injuring the ligaments.

In addition to road accidents, injuries can be caused by falls from a height, in which a person lands on a bent, outward or abducted leg. The most rare, but possible cause of the disease is various large-scale disasters and natural disasters.

Pathology with the possibility of timely reduction is more common in adults who are under 50 years of age, but such injuries in older people are much more likely to result in fractures.

Dislocations in the hip area occur as a result of indirect trauma. In this case, it is the femur that receives the role of a specific lever that affects the entire hip joint.

After implementing the forced influence, the tip of the femur:

tears the capsular cavity of the joint;

destroys or damages ligaments;

comes out of the cavity into the joint area.

The cause of a posterior hip dislocation is usually a car injury. The mechanism of such a detrimental effect is a noticeable rotation or extension of the limb turned towards the inside, adducted and tucked.

Taking into account the peculiarities of the anatomy of the hip joint, it is easy to understand that in order to dislocate it, a fairly significant force will be required, applied at a considerable speed. Most often these are road accidents, falls from heights and sports injuries. But such a dislocation is not always an acquired condition and can also be congenital or a consequence of developmental pathology.

By the way, pathological conditions are often observed in children and are better known as “hip dysplasia.” If we are still talking not about congenital, but about traumatic dislocations of the hip, then they are often accompanied by damage to soft tissues, ligamentous apparatus and femur fractures.

During a dislocation, the mechanism of action on the joint is characterized by a sharp inward rotation with simultaneous adduction of the hip.

Hip dislocation according to the ICD 10 code is listed as S73.0.

There are several types of dislocations.

Front

The causes of damage, as well as fractures, can be the most unpredictable. A person may not even be aware of the cause of pain in the pelvic area, which appeared without a fall, injury or stress.

At the same time, the older the person, the more vigilantly it is necessary to monitor the corresponding symptoms, especially for people over 50 years of age.

Symptoms of injury: how to distinguish from a fracture

The presence of the described problem can be judged by the following signs:

• severe pain in the pelvic area;
• inability to stand on a leg (injured);
• deformed appearance limb, which depends on the characteristics of the dislocation (for example, with the posterior type of injury, the leg will be bent, turned inward and slightly shorter than the other, while the anterior dislocation implies an extended or bent position of the injured limb and its lengthening).

Moreover, if nerve damage occurs during injury, the patient will have no sensation in the foot and ankle joint area.

It will be possible to make a final diagnosis of a hip dislocation based on the existing symptoms only after analyzing the position of the injured limb and a number of other diagnostic procedures (for example, if a fracture of the pelvic bones is suspected, doctors take an X-ray).

Clinical picture

Symptoms of hip joint dislocation vary significantly between newborns and adults.

In children

In a newborn child, joint lability is observed - that is, the head of the femur can independently enter and exit the acetabulum. This process is called preluxation. If the diagnosis is not made in a timely manner and the child is not properly cared for, it can transform into a full-fledged dislocation.

The symptoms of congenital dislocation are very minor and it can be quite difficult to detect the injury. The main sign of hip dislocation in a newborn baby is the symptom of slipping.

Its appearance is caused by imperfect development of the ligamentous apparatus. One more important symptom is the asymmetry of the skin folds - subgluteal and popliteal.

More pronounced symptoms are observed after the age of one year, when the child learns to walk:

• gait disturbance;
• shortening of the limb;
• with bilateral dislocation, increased lumbar lordosis is noted.

If left untreated, the dislocation progresses and irreversible consequences may occur.

In adults

If hip joint dislocation occurs in adults, the symptoms will be more pronounced. Immediately after the injury, the person feels a sharp pain and is unable to stand on the affected leg or make any movements with it.

The leg is in an unnatural position - depending on which direction the dislocation occurred:

• with a posterior dislocation, the leg is bent and turned inward;
• with an anterior dislocation, the leg is abducted and turned outward.

Passive movements in the joint provoke severe pain, and resistance to load is noted. On palpation, the head of the femur is located outside the glenoid cavity.

When a dislocation occurs, damage occurs to one of the ligaments, inside of which the artery is located. Therefore, the immediate symptoms of injury are accompanied by signs of bleeding - pale skin, increased heart rate, low blood pressure. There is a high risk of damage to the sciatic nerve.

Subluxation of the hip joint in adults is quite rare, mainly due to diseases of the muscles and ligaments, and bone dysplasia. The manifestations are practically no different from complete dislocation.

Types of injuries

Distinguishing between anterior and posterior hip dislocations, it is worth determining their characteristics and varieties. The anterior ones are divided into anterosuperior and anterioinferior. Posterior dislocations, which occur 5 times more often than anterior ones, are classified similarly.

Common symptoms of hip dislocation in adults:

• joint deformity;
• forced unnatural position of the injured leg;
• sharp pain in the hip joint;
• shortening of the limb;
• the patient observes springy resistance.

There are several distinctive symptoms different types injuries. With posterior dislocations, the leg is in an adducted and bent position, turned inward. Difference in bone position:

• Posterosuperior dislocation. The head of the bone can be felt under the gluteal muscles.
• Postoinferior dislocation. The head of the femur can be found next to the ischium.

Anterior injuries are characterized by compression of the femoral vessels. In some cases, they are accompanied by a separation of the edge of the acetabulum, as well as injury to the femoral head. Features of anterior dislocations:

• Anterosuperior dislocation. The leg turned outward is slightly bent at the knee and hip joints. Nerves may be compressed, causing sensation in the lower leg and thigh to change.
• Anteroposterior. The leg is strongly bent at the knee, the thigh is almost perpendicular to the longitudinal axis of the body. The head of the femur is firmly fixed in a forced position.

With old dislocations, the clinical picture is less pronounced. Joint pain decreases over time. To clarify the position of the head of the bone and exclude its damage, the doctor prescribes additional studies.

The classification of hip dislocations is carried out according to several principles. First of all, it is necessary to highlight the anterior and posterior dislocations of this area.

Dislocations in the anterior part should be divided into anterior and superior (suprapubic), as well as anterior and inferior (obturator). The posterior ones are classified as follows: posterior and superior (iliac), as well as posterior and inferior (sciatic). Considering the presented classification, the treatment process may be different, depending on the nuances of the diagnosis.

A separate category of hip dislocation is a birth defect. Research carried out to date has proven that dysplasia is the basis of congenital dislocation in the hip area. We are talking about a violation of the optimal formation of each part of the joint presented throughout the entire development in the mother’s womb.

These initial dysfunctions become catalysts for further ones: incomplete development of the pelvic bones, movement of the top of the femur, slowing down the process of ossification (ossification) of the described elements of the joint.

There are four types of the described problem, and their classification is based on the direction of the head of the femur. These include:

• posterosuperior (the head will be placed behind the wing of the ilium);
• posteroinferior (the head is located near the ischium);
• anterosuperior (the head is located in front of the wing of the ilium);
• anteroinferior (the head is located next to the pubic bone).

Posterior types of hip dislocations are more common, approximately 3-5 times more common than the anterior ones.

The hip joint is formed by the convex head of the femur and the concave surface of the acetabulum of the pelvic bone. The head of the femur enters 2/3 of the acetabulum. The area of ​​the hip joint is increased by cartilaginous tissue located along the edge of the acetabulum. The joint is held in place by the capsule and powerful ligaments.​

1. ​As statistics show, the most common complication after this diagnosis is coxarthrosis, which is degenerative changes in the diseased joint. Often, against the background of various injuries, a disease such as arthritis of the hip joint can develop.
2. ​Recovery and rehabilitation.​
3. In addition, with a congenital hip, infants experience

​Inexperienced parents should also take into account that they should not swaddle their baby too tightly. With the possibility of natural movement of the legs, the child’s joints have the opportunity to form correctly.​​The anterior one is extremely rare​

​X-ray diagnostics and diagnostics using ultrasound are also of great importance. However, ultrasound is considered the gold standard for determining this pathology. That is why every child undergoes an ultrasound of the hip joint in the first few days after birth.​​Diseases and disorders A - Z​

​After initial period recovery, you should begin performing a series of exercises to maintain the flexibility and range of motion of the hip joint, as recommended by your doctor. ​​Traumatic dislocation of the hip is accompanied by a reflex contraction of the powerful muscles of the thigh and gluteal region.

For successful reduction, it is necessary to effectively relax these muscles, so reduction of a dislocated hip is performed in a hospital setting under general anesthesia using muscle relaxants. ​​The patient complains of sharp pain in the hip joint.

All types of hip dislocations are characterized by a forced position of the limb, deformation of the hip joint, and more or less pronounced shortening of the limb on the side of the injury. Passive movements in the hip joint are painful, sharply limited, and accompanied by springy resistance.

Active movements are impossible. ​​In traumatology, anterior and posterior hip dislocations are distinguished.

Anterior dislocations, in turn, are divided into anterosuperior (suprapubic) and anterioinferior (obturator), and posterior dislocations into posterosuperior (iliac) and posteroinferior (sciatic). ​

​The result of untimely detection and treatment,​

​First of all, the doctor attempts to realign the joint and return it to its normal position. Since the hip joint is surrounded by a muscle mass, to relieve sharp pain during reduction manipulations, it is recommended to use anesthesia and special drugs (muscle relaxants) aimed at muscle relaxation.​

Such dislocations are classified based on the nature of their origin:

• Traumatic
  Develops due to direct impact on the joint (impact, pressure). As a rule, such a dislocation is accompanied by ruptures inside the joint capsule. The condition can be complicated by tissue entrapment and bone fractures.
• Pathological
  Most often, pathological dislocation of the hip joint is the result of joint inflammation.
• Congenital
  Associated with developmental pathologies that occur during intrauterine development. Congenital dislocation is diagnosed in newborns and children under 1 year of age.

Injuries are also divided into types:

• posterior dislocation
  This dislocation is characterized by damage to the head of the femur, which extends backward and upward relative to the joint. This type of injury can often occur in car accidents.
• anterior dislocation
  When an injury occurs, the joint capsule ruptures and the head of the bone moves forward with a downward displacement. A similar injury occurs when falling on a limb rotated outward.
• central dislocation
  A very serious injury, characterized by protrusion of the head of the bone and retraction of the great nerve. With this type of dislocation, the acetabulum is destroyed.

In this article we talk about all possible reasons pain in the hip joint. What pain in the hips can mean during pregnancy, read here

Depending on the origin, the pathology can be congenital or acquired. According to statistics, 1 out of 7 thousand newborns are born with a subluxation or dislocation of one hip joint.

In children, the relationship of synovial components is disturbed, the head of the femur is displaced or located outside the acetabulum.

The cause of the formation of pathological dislocation is a long-term inflammatory process in the joint tissues, causing the destruction of cartilage and bone structures. Displacement of the head can be observed with tuberculosis, osteomyelitis, in elderly patients against the background age-related changes.

There are anterior and posterior hip dislocations. The first type, in turn, is divided into:

• obturator (anteroinferior) – the head moves towards the pubic bone;
• pubic (anterosuperior) – the head moves anteriorly from the wing of the ilium.

The type of pathology depends on the position in which the limb was at the time of injury. Anterior hip dislocations occur in 15% of cases and are the result of forced abduction, which leads to strong blow neck or greater trochanter on the roof of the glenoid cavity. Lever-shaped dislocation of the head and perforation of the anterior wall of the articular capsule occurs.

Depending on the location and location of the injury, hip dislocation has different kinds. It should be noted that depending on the type, the symptoms will also differ.

Of particular danger are fractures near the head of the joint, which, as a rule, leads to impaired circulation and sudden death of tissue.

Treatment of newborns, children

Hip dislocation in a child is a congenital pathology in which the formation of elements of the hip joint is disrupted in the form of underdevelopment of the femoral head or irregular shape acetabulum. Often a dislocation of one hip is accompanied by a subluxation of the other. Symptoms of the pathology are asymmetry of the folds on the skin of the child’s legs and visual shortening of one of the limbs.

Hip dislocation in children is treated conservatively or surgically. An orthopedic surgeon treats congenital pathologies in the form of dislocations and subluxations of the hips in children. The earlier joint dysplasia is detected, the higher the likelihood of curing the child with the help of conservative methods. This treatment is used on early stages and usually includes:

• wide swaddling of babies up to six months;
• Pavlik stirrups, plaster casting, Volkov splints or orthopedic pads for children under two years of age.

Required element complex treatment is a massage.

In cases where conservative treatment does not produce positive results, or dysplasia is detected too late, surgery is prescribed to correct the pathology.

For the treatment of children with hip dislocation (congenital or traumatic), both conservative and surgical treatment. Most often, surgical intervention is not performed in newborns, however, in case of complex congenital dislocation, the baby is indicated for just such treatment.

As a treatment for children, a splint is used to fix the newborn’s legs in a position in which they are bent at the knee and hip joints at an angle of 90° or abducted at the joints.

This helps the correct formation of joints in the future. The reduction is carried out smoothly, gradually, avoiding the possibility of injury.

It is unacceptable to make significant efforts when carrying out the procedure for newborn children.

Experts advise using wide swaddling for the newborn and performing therapeutic exercises.

Causes and mechanism of injury in adults

Reduction according to Dzhanilidze

Reduction of a dislocated joint in adults using these methods is carried out as follows:

1. after introducing the patient into deep anesthesia, he is placed on the table face down so that the affected limb hangs freely;
2. two bags filled with sand are placed under the person’s pelvis;
3. the doctor's assistant presses on the patient's sacrum, fixing it;
4. the surgeon bends the patient’s leg at the knee and places his knee in his popliteal fossa;
5. By persistently pressing with the knee, the specialist turns the injured leg outward.

Kocher reduction

When the first method does not produce positive results, they resort to the Kocher reduction method, which is carried out exclusively in adults in the following order:

1. the patient is put under anesthesia and placed face up on the table;
2. the patient's pelvis is securely fixed by the doctor's assistant;
3. the surgeon bends the leg at the knee and hip, makes several sharp circular movements of the patient’s affected leg, due to which the natural position of the joint is restored.

The described treatment methods are not suitable for children!

After reduction

After the manipulation is completed, a splint is applied to the patient in such a way as to fix the hip, knee and ankle joints. It happens that after reduction, skeletal traction must be applied. This is done as follows:

1. After the patient is put under anesthesia, a surgical wire is passed through the tibia, onto which a clamp with a weight is attached.
2. After reduction, strict bed rest is indicated for at least a month. After this period, the patient is allowed to walk using crutches for support, which must be used for a further 2-3 months.

Symptoms

Symptoms of dislocation should be divided into a subcategory of general and those that depend on the type of displacement itself. In the first case we are talking about:

• severe and sharp pain in the hip joint;
• the inability of a person to step on the injured leg, as well as to make any movements in the hip area;
• uncharacteristic position of the injured leg;
• the presence of swelling and subcutaneous hemorrhages;
• springy resistance of the body when trying to move the leg.

In the posterior direction of displacement, the patient is characterized by a bent and inwardly rotated leg, which looks shortened compared to a healthy one. In this case, you can also find a recess in the groin area and a protrusion in the buttock area, which is the head of the femur.

For anterior displacement, experts note the abducted position of the leg with the knee turned outward. If the leg is bent, the injury is considered anteroinferior. When the lower limb is extended, in such cases it is customary to talk about the anterosuperior direction of the head. The damaged leg should be longer than the healthy one, and a characteristic bulge is observed in the groin area.

In any case, correct and timely treatment of the dislocation by trained specialists is extremely important, since only in this case is it possible to avoid more dangerous complications. First aid should also be provided by professionals.

Pain and limited mobility are the main signs of injury. Symptoms of hip dislocation vary depending on the direction of the hip dislocation. For anterior hip dislocation, symptoms include:

• a round formation in the groin - the head of the femur protrudes, creating a noticeable swelling;
• visible lengthening of the injured leg;
• the knee is turned outward.

Pain in the hip joint also accompanies posterior dislocation. But other appearances vary. So, the affected leg is shortened and the knee is turned inward. Deformations are visible to the naked eye. In the buttock area there is swelling on the affected side.

In children, symptoms include asymmetrical positioning lower limbs. It is not always possible to recognize the disease immediately after the birth of a child. Dysplasia is characterized by the appearance of a click when spreading the legs, excessive muscle tension, and asymmetry of the skin folds on the legs.

Signs of endoprosthesis dislocation include lack of balance when walking, pain, and decreased ability to support. Cases of deformation of the hip joint after endoprosthetics are not uncommon, therefore, upon discharge, the patient is instructed regarding safety and correction of living conditions.

If a dislocation in the hip joint is accompanied by fractures, the symptoms will be more pronounced. Deformations are usually visible even to a non-specialist. The victim experiences unbearable pain and cannot walk. To choose the right treatment, recognize the symptoms. Limb injuries have a lot in common, and before starting therapy you need to make sure that it is a dislocation.

Symptoms of a hip dislocation should be differentiated depending on the type of injury. In general, the victim complains of quite serious pain in the hip joints.

In addition to deformation and forced positioning of the injured limb, the main symptom of hip dislocation is severe pain. With a posterior hip dislocation, the leg bends and the knee rotates inward. The greater the flexion, the greater the likelihood of sciatic posterior hip dislocation. Accordingly, with an iliac dislocation, the leg is bent less.

Each type of hip dislocation is characterized by the following physical manifestations:

forced placement of a limb;

change in the shape of the hip joint;

strongly or not very much, but, nevertheless, obvious shortening of the leg on the side where the damage occurred.

Even the most insignificant displacements in the area of ​​the presented joint are painful, sharply limited and are accompanied by specific resistance. If we talk about more active movements, then they seem impossible.

In the case of an anterior dislocation, the person’s limb is turned to the outer part, retracted to the side. At the same time, it will also be bent not only in the hip, but also in the knee joint. Anterior and inferior dislocation resolves with more obvious flexion and abduction of the injured area.

Dislocations that occur directly in the hip can be accompanied by and with the separation of a small part of the vertigo. In some cases, the cartilage at the top of the femur is broken.

With posterior and lower hip injuries, severe contusion of the sciatic nerve is often determined. When the hip is dislocated in the anterior part, compression of the femoral vessels is likely; in the anterior and lower part, there is strong pressure on the obturator nerves, which causes sharp pain.

​limitation when abducting the hips to the sides

• ​Hip dislocation in most cases is accompanied by the following symptoms:​
• ​. Most often caused by an indirect impact, for example, a fall from a significant height on a leg that is moved to the side. In this case, the head of the femoral bone is characterized by a downward shift and is accompanied by a rupture of the joint capsule. These types of dislocations, in turn, are suprapubic or anterosuperior and obturator or anterioinferior.​
• ​All these symptoms of a hip dislocation in a child and timely diagnostic testing allow treatment to begin as early as possible. This means that this will help to avoid very serious complications with this pathology.​
• ​Hip dislocation​

​Your doctor may refer you to a physical therapist to help speed up your recovery from a hip dislocation.​

​When reducing fresh anteroinferior, posteroinferior and posterolateral hip dislocations, the Dzhanelidze method is used; when resetting old and fresh anterosuperior dislocations, the Kocher method is used. For anterosuperior hip dislocations, the Dzhanelidze method is not used, since there is a danger of breaking the femoral neck during the reduction process.​

The forced position of the limb is determined by the location of the femoral head in relation to the acetabulum. In posterior dislocations, the patient's leg is adducted, bent, and the knee is turned inward. With posteroinferior hip dislocation, the deformation of the hip joint is more pronounced than with posterosuperior dislocation.

​Posterior hip dislocations are approximately 5 times more common than anterior ones.​​Gait disturbance or lameness may occur.​After successful reduction, the patient will have to wear a special traction splint for one month.​

​. This symptom can be detected mainly in children under 1 year of age. With the natural development of the hip joint, the angle of abduction to the sides of the baby’s legs, bent at the knee and hip joints, should be from 80 to 90 degrees. In case of pathology, it will be limited.​

General symptoms and photos of hip dislocation:

• sharp, severe pain;
• forced unnatural position of the leg;
• shortening of the leg (on the side of the disorder);
• joint deformity;
• significant motor restrictions.

With an anterior dislocation, there is a slight flexion of the limb at the joint and abduction to the side, the knee facing outward.

With a posterior dislocation, the knee is directed inward, the limb is bent at the hip joint, and brought toward the body. Shortening of the leg on the side of the injury is often noted.

Central dislocation is characterized by severe pain, joint deformation, and shortening of the leg. The knee can be slightly turned both outward and inward.

Symptoms of a hip dislocation mostly depend on where the injury was and its severity. Patients often complain of severe pain in the pelvis. Often in this case it becomes impossible to move.

Any type of hip dislocation is characterized by deformation and contraction of the injured limb. The degree of severity will be different in all cases. Restriction occurs motor function, it is accompanied by severe pain.

With an old type of dislocation, the symptoms are not so pronounced.

The obligatory and most characteristic symptoms for any traumatic hip dislocation are pathological position and limited mobility of the limb.

With posterior hip dislocations, the forced position is characterized by adduction and inward rotation of the bent (in case of posterior-inferior) or straightened (in case of posterior-superior dislocation) limb.

With anterior dislocations, the limb is turned outward and abducted, while similarly to posterior dislocations, it can be bent (in the case of anterior-inferior dislocation) or straightened (in the case of anterior-superior dislocation).

Active movements in the hip joint during dislocation are absent, passive ones are extremely painful and also limited in scope. Characteristic is “spring mobility”, when when you try to change the position of the limb, resistance is felt and it returns to its original state.

Forced position of the limb during hip dislocation

Upon palpation, a displaced head of the femur is determined; depending on the direction of the dislocation, it can be located in the gluteal region or in the groin.

This injury is characterized by the same basic symptoms as other dislocations. First of all, the patient complains of severe pain in the joint area. Because of it, any movement is impossible. Often the patient cannot even sit. Externally, the forced position of the limb and the deformation of the joint are noticeable. Leg shortening may also occur. The area of ​​the hip joint, groin and buttocks becomes very swollen.

Features of joint deformation depend on the type of dislocation. When the bone moves forward, the leg is bent and moved to the side, the knee is turned outward. The buttock area becomes flat. With a posterior dislocation, the limb is turned inward by the knee and is also bent.

Symptoms of a hip dislocation may be less severe if the injury did not occur on the day you visited the doctor, but earlier. The pain gradually subsides, the shortening of the limb is smoothed out due to the displacement of the pelvis. This increases the risk of complications. Traumatic hip dislocation can lead to the following consequences:

• pinched sciatic nerve;
• compression or rupture of the femoral artery;
• ligament or muscle rupture.

Diagnostics

Determining the degree of violation and further research are prescribed by a traumatologist after an initial examination. The disease is easy to determine by palpation, but it is extremely important to exclude a possible fracture, subluxation or severe bruise, since further treatment of these disorders is fundamentally different from reduction.

You can confirm or refute the doctor’s diagnosis after taking an x-ray. In this case, photographs should be taken not only from the side, but also from the front. This is the only way to accurately determine the position of the displaced head, as well as assess the degree of damage to the femoral neck and nearby tissues.

A computed tomography scan or MRI is prescribed if the attending physician still has doubts about the diagnosis.

The main method for detecting a dislocation is ultrasound and x-ray of the affected area in frontal and lateral projection. Research allows us to understand how and to what extent bone structures are displaced. When studying the results, you can find associated fractures. A medical examination also plays a significant role in the diagnosis of injury.

If there is doubt, an MRI is prescribed. When symptoms of dislocation are detected in a child, you should contact a pediatric orthopedist. Diagnosis is carried out within 3 months after birth.

Hip dislocation can be determined using radiography. Pictures are taken in two projections for a more accurate understanding of the damage.

Early diagnosis methods childhood will differ. Usually, children with suspected dysplasia are prescribed an ultrasound.

Up to 6 weeks, doubts about the informativeness of the method may remain. After this period, all joints return to normal, and if there is prolapse of the femoral head, it can be detected during the study.

A diagnosis of “subluxation” is often made – that is, incomplete prolapse of the head. Ultrasound allows you to evaluate not only the position of the joint, but also its stability. To do this, dynamic tests are carried out while the sensor is moving along the surface of the thigh.

Diagnosis and treatment of subluxations in adulthood differ slightly. For unexplained injuries, an MRI is recommended.

An ultrasound is also prescribed, which is considered more informative. Ultrasound examination allows us to identify all pathologies of the hip area, including inflammatory processes, damage to large vessels, metastasis, if malignant tumors can be suspected.

Because clinical picture is not enough to make a diagnosis, both children and adults are instrumental examination:

1. To diagnose congenital dislocation in a child, it is preferable to use ultrasound (see. Ultrasound of joints - why do it, what will it show?). Subluxation of the hip joint is visible quite well on ultrasound. The method allows you to avoid radiological load on the child’s body. However, it should be borne in mind that the result must be deciphered by qualified specialists.
2. Radiography is the initial diagnostic method for dislocation in adults. It is also carried out in children - if necessary.
3. Computed tomography allows you to evaluate not only the condition of bone structures, but also soft tissues. Can be performed on both children and adults.

The photo shows various options instrumental diagnostics subluxation.

Making a diagnosis of “hip dislocation” in the vast majority of cases does not cause any difficulties for a traumatologist or any other specialist. In order to clarify the position of the end of the femur and exclude possible bone damage, it is necessary to conduct an X-ray study. Moreover, it must be in two projections.

In the same case, if the diagnosis is in doubt, an MRI of the entire joint in question is performed.

Found an error in the text? Select it and a few more words, press Ctrl Enter

The victim will undergo a diagnostic stage, which consists of:

• examination by a traumatologist (a specialist examines and feels the damaged joint),
• radiography, which is mandatory (pictures are usually taken in two projections: side and front),
• computer and magnetic resonance imaging.

The latter diagnostic procedures are not always prescribed, but only in cases where X-ray examination is not enough to make a final diagnosis.

In most cases, hip dislocation is not difficult to diagnose, but it is important to learn about its features and correctly identify the problem.

​Injury is considered medium degree severity, but in an advanced stage it is quite difficult to treat. It is worth noting that mainly girls suffer from this pathology.

The reason for this situation is joint dysplasia, which means a violation of the intrauterine development of the joint due to the narrow pelvis of the mother. In this case, the pelvic bones may remain underdeveloped, and the femoral head begins to shift and the process of ossification of the articular elements slows down.

​Congenital.​

​Another important criterion for diagnosing the disease is the phenomenon of femoral shortening. The test is performed as follows: the child must be placed on his back, his legs bent at the knees and hip joints. In this case, the knee on the affected side will be located slightly lower than the healthy one. This test indicates that the baby has the most severe degree of pathology.​

​Consult your doctor about treatment chronic diseases joints.​

In order to confirm the presence of this injury, a consultation with a traumatologist is necessary. He examines the patient, palpates the damaged area, and studies the symptoms.

Every patient without exception needs to do X-ray in anterior and lateral projections. This method allows you to find out the exact location of the head of the bone and determine the probable tissue damage.

CT and MRI are performed when radiography does not provide the necessary information to confirm the diagnosis.

Diagnosing an injury is not particularly difficult, since its signs can be visually identified. In all cases, the incorrect position of the limb is visible. In addition, large hematomas are possible in the femoral area. Sharp pain during passive movements and lack of activity also confirm the diagnosis.

X-rays are used to determine the type of dislocation. The picture is taken in lateral and frontal projections. The injury is classified based on how the femoral head is positioned at the time.

Hip dislocation should be distinguished from bruises, subluxations and various fractures of the femur or pelvic bones.

If such an injury is suspected, the victim must be taken to a medical facility as soon as possible. It is not recommended to adjust a dislocated hip or move an injured limb on your own.

The pelvic area contains many important nerves and blood vessels, so if the bones are displaced, they can be damaged. Improper reduction of a dislocation can lead to damage to cartilage tissue and bone necrosis, which greatly increases the patient’s rehabilitation period.

In addition, externally, the symptoms of a dislocation can easily be confused with a fracture of the femoral neck or pelvis.

The victim must be placed on a hard surface and the limb should be secured. It can be bandaged to a healthy leg or a homemade splint, but only in the position that the victim assumed after the injury. You can apply a cold compress to the joint area, and if the pain is severe, use a painkiller.

All further actions are carried out in a medical institution. After examining and palpating the joint area, the doctor makes a diagnosis. To confirm it, as well as to exclude concomitant bone damage, it is necessary to conduct an x-ray or ultrasound examination. Sometimes an MRI is additionally prescribed. This is necessary if damage to soft tissues and blood vessels is suspected.

Treatment

The main method of treating hip dislocation in adults is repositioning (returning to place) the head of the femur. The procedure is performed under general anesthesia. To prevent necrosis of the end of the bone, treatment must be carried out within the first 24 hours after the patient dislocates the joint. Old damage is eliminated surgically.

The head of the femur is adjusted using two methods – Kocher and Janelidze. The first option is applicable for anterosuperior dislocations, the second - for anterior and posterior obturator dislocations. Before the procedure, the patient is given anesthesia. It is necessary because the procedure is very painful. The patient is also administered muscle relaxants - with relaxed muscles, reduction is much easier.

Depending on the method of therapy, the joint is adjusted at a certain position of the victim’s body. The surgeon needs the help of an assistant.

After the hip returns to its normal position, the injured limb is limited in movement and skeletal traction is performed for 3-4 weeks. This ensures rest for the hip joint and accelerates the healing of the torn capsule. A plaster cast is rarely applied; a Beler splint is more often used.

After hip reduction, the patient remains in bed until the splint is removed. You cannot sit for 1-3 months.

Surgery is prescribed in the following cases:

• it is not possible to straighten the joint using a closed method;
• torn ligaments;
• congenital or old dislocation;
• The socket, head or neck of the femur is broken.

TO surgical methods Treatments include arthroplasty, arthrotomy and endoprosthetics.

A hip dislocation requires hospital treatment.

Providing first aid to the victim includes pain relief, immobilization of the injured leg and psychological preparation to further hospitalization. Ladder splints are often used to immobilize the injured limb.

Treatment for hip dislocation in the hospital consists of immediate reduction and short-term fixation of the injured limb, followed by mandatory rehabilitation of the patient. If the damage is not treated by reduction, then over time it becomes old: the capsule of the femoral joint thickens, its free space becomes overgrown connective tissue and ossifies.

This pathology is eliminated mainly through surgery. IN in some cases When the hip is dislocated and the integrity of the cartilaginous cover of the femoral head is damaged, the victim eventually develops deforming arthrosis, requiring replacement (endoprosthetics) of the joint.

Reduction

Reduction of hip dislocation, depending on the type of injury, is carried out in two ways. Before reduction, general anesthesia and muscle relaxants are used to pre-relax the muscles of the injured leg.

The Dzhanelidze method is used for the reduction of fresh posterior and anterioinferior displacements; it is not used for the reduction of anterosuperior dislocations, since there is a significant risk of damage to the femoral neck. The Koch method is used to reduce old displacements and fresh suprapubic dislocations.

Fixation

After reduction of the dislocation, the patient is placed in skeletal traction for a period of 3 to 4 weeks. For this purpose, a Beler splint is used. This procedure makes it possible to build up cartilage tissue on the head of the femur and restore the movement of elements in injured joints.

Over the next 10 days after removal of skeletal traction, the patient is recommended to stand up and walk on crutches without leaning on the sore leg; sitting positions should be avoided. During this time, the patient is prescribed active rehabilitation procedures.

The treatment process is quite simple and involves the fastest possible reduction and fairly short fixation. After this, it is imperative to carry out specific therapy (physiological procedures and therapeutic exercises).

A traumatic type of dislocation in the hip area is accompanied by a reflex contraction of the large muscles of the thigh and gluteal regions. For successful and competent reduction, these muscles should be relaxed as much as possible.

In this regard, reduction of femoral dislocation is carried out in hospital treatment under general anesthesia using muscle relaxants. This should be considered an indispensable condition.

In the process of reducing recently received anterior and inferior, posteroinferior and posterolateral injuries of the hip, the Dzhanelidze method should be used (as the least traumatic, but quite painful). If we are talking about the reduction of older or fresh anterior and superior dislocations, then the Kocher method will be relevant.

In the case of anterior and superior dislocations in the hip area, the Dzhanelidze method is not used, because the likelihood of breaking the tip of the femur during reduction is too high.

After skeletal traction has been applied, it must be continued for at least three to four weeks. After this, the victim will need to move with crutches for about 10 weeks. We are also talking about prescribing special therapy and therapeutic exercises.

Damage to the cartilage at the end of the femoral bone during its dislocation is almost always accompanied by the development of arthrosis of the hip joint, which becomes a catalyst for changes in its shape. An alternative name for the presented phenomenon is coxarthrosis in the long-term period.

A victim with a dislocated hip can expect the head of the bone to be reduced to its natural position. For this, doctors use several methods: Kefer-Kocher, Janelidze-Collen, Depres-Bigelow. Since this procedure is quite painful, most often it is performed under local anesthesia, although in particularly difficult cases general anesthesia can also be used.

To assess the correctness of the reduction, it is necessary to take a repeat radiograph of the hip or computed tomography.

After the procedure, a plaster cast is applied to the injured limb (from the lower back to the very toes) so that it fixes three joints at once: ankle, knee and hip. In some situations, it may be necessary to apply skeletal traction for a period of 3-4 weeks.

You can also learn by watching this video how the procedure for reducing hip dislocation using the Kocher method is performed.

The procedure involves passing a metal wire through the tibia and hanging a weight from it. During this entire time, the patient is prescribed bed rest, and after a month, another 8-10 weeks are prohibited from putting any weight on the injured limb (you can only walk with the use of crutches). Most often, full recovery occurs only after three months.

If the reduction of the hip dislocation occurred immediately after the injury, that is, you quickly figured out what to do, then the further prognosis is quite favorable.

​Every mother should know that the previously common tight swaddling, or swaddling with a “soldier”, is strictly contraindicated for this pathology, since this disrupts blood circulation in the joints, and this is the reason for the disruption of their nutrition.​

​When driving in a car, use a seat belt;​​Damage to the cartilage of the femoral head during hip dislocation often leads to the development of deforming arthrosis of the hip joint (coxarthrosis) in the long term.

In such cases, with severe development of disorders in the joint, hip replacement may be required - its removal and installation of a prosthesis. ​​With a posterosuperior hip dislocation, the head of the femur is palpated under the muscles of the buttocks, with a posteroinferior dislocation - next to the ischium.

​b – posteroinferior dislocation

Complications of hip dislocations include: impossibility of reduction using the Kocher or Dzhanilidze method. This happens when reduction is interfered with by the joint capsule or tissues that are caught in the gap between the acetabulum and the head of the bone; ligament rupture.

In such cases, surgical treatment is performed, during which the surgeon makes an incision that gives him access to the damaged joint. The doctor eliminates all abnormalities (tissue trapped in the joint, stitches the ligaments) and realigns the head of the bone.

Operation

To treat an old dislocation, two types of operations are used:

• Open reduction, which can only be carried out when the articular surfaces are preserved. Arthrodesis is the fixation of a joint whose changes are irreversible and whose functions are completely lost. After something like this surgical intervention the patient can lean on the injured limb.
• Endoprosthetics

A treatment method in which a damaged joint is replaced with an artificial one that fully matches the structure of a healthy joint. The selection of an endoprosthesis is made individually and depends on the following parameters:

• general health of the patient;
• age;
• Lifestyle.

The goal of endoprosthetics is to reduce pain in the joint and restore its functionality. The service life of the endoprosthesis is up to 20 years, after which it is replaced.

This pathology is dealt with by a traumatologist and orthopedist.

With a simple injury, the prognosis is favorable. The treatment and rehabilitation carried out most often provides a guarantee that the patient will return to ordinary life. Timely treatment more complex dislocations also lead to a complete recovery, but in this case there is a risk of developing degenerative pathologies of the joint in the future.

For hip dislocations, the closed reduction method is used under general anesthesia. It is necessary to treat within the first 24 hours because the injury can cause circulatory problems and necrosis of the head. Old injuries and comminuted fractures require surgical intervention.

Most often, the Dzhanelidze and Kocher method is used to reposition the hip joint.

The first option is used for posterior and anterior obturator dislocations, the second – for anterosuperior ones. The patient is given general anesthesia, as the procedure is quite painful, and muscle relaxants to relax tense muscle fibers.

The joint must be adjusted in a certain position depending on the method of therapy. The surgeon performs manipulations with the help of an assistant, achieving restoration of the correct position of the joint, which is accompanied by a characteristic click.

For injuries of the hip joints are used drug treatment and physical therapy. With timely assistance, serious consequences can be prevented.

In adults

Treatment in adults begins only after an accurate diagnosis has been made as a result of an MRI or X-ray. All procedures must be carried out in a hospital setting under the supervision of specialists.

Treatment of injury consists of several stages:

• reduction of dislocation;
• fixation using plaster;
• period of rehabilitation and recovery.

Today there are two effective methods of reduction:

1. Dzhanelidze method. Used in many cases, except when an oblique dislocation is diagnosed. The procedure is as follows:
   • the patient is placed on the table, his face should be looking down;
   • the injured limb hangs down;
   • within 10–15 minutes it should take a right angle relative to the body;
   • after this, the trauma surgeon makes precise movements in the knee and hip joints, thanks to which the head returns to the acetabulum (an unpleasant click will be evidence of this);
   • With proper reduction, it becomes possible to passively move the limb.
2. Kocher-Kefer method. It is used when the first one did not bring a positive result. The patient is also horizontal, but face up. When fixing the pelvis, the surgeon, holding the damaged limb in his hand, makes several sharp movements, as a result of which the joint is moved into place.

After reduction, the patient is placed in skeletal traction.

In newborns and children

To avoid hip dislocation in newborns, it is necessary to promptly begin treatment for identified dysplasia. The main task is to ensure that the blood supply to the pelvic area is maximized, and the legs should be bent and spread apart. This ensures proper development the entire joint.

Pathology in children can be detected even before visiting a doctor. Attention is drawn to how symmetrically the folds are located relative to each other. If you try to spread your legs apart, this will cause difficulty.

In all cases of traumatic hip dislocation, the patient requires emergency hospitalization. The treatment method for traumatic dislocation depends on its severity and the presence or absence of concomitant damage to soft tissue and bone.

In case of uncomplicated hip dislocation, after radiography and clarification of the type of dislocation, the patient is transferred to the operating room. Reduction of the dislocation must be performed under anesthesia and against the background of the administration of muscle relaxants (substances that relax the muscles).

The technique for reducing various hip dislocations differs markedly. In general, when reducing a dislocation, the doctor repeats the impact that led to the injury in reverse order.

Thus, the head of the femur repeats its path, eventually returning to the acetabulum.

In case of complicated dislocations, surgery is often required to suturing torn ligaments and/or replacing bone fragments.

Bed rest in the post-traumatic period is strictly mandatory.

Further treatment tactics are individual. For uncomplicated dislocations, immobilization is required for up to three weeks and then the use of crutches for a period of 10 days to two months. With successful rehabilitation, these periods can be reduced.

If associated injuries are present, a cast, skeletal traction, or bone fixation may be indicated. In such cases, the treatment period may increase significantly.

In all cases, treatment of hip dislocation occurs under the constant supervision of a traumatologist with control X-rays taken, assessment of the success of the prescribed treatment, the rate of restoration of joint function and appropriate correction of the current treatment.

Medical intervention is mandatory in the treatment of this diagnosis.

The direction of treatment depends on the severity of the injury and its neglect, as well as the reasons for its receipt and the age of the patient.

As a rule, treatment is carried out in two directions: conservative and surgical.

Conservative treatment consists of fixing the limb and pelvis, possibly in plaster, and completely immobilizing them for a certain time.

Surgical intervention involves the implantation of a prosthesis into the bone, that is, endoprosthetics of the patient’s hip joint. The process involves inserting an implant to replace a damaged part of a joint or bone.

Required condition rehabilitation is the implementation of a complex physical exercise and massages, which will avoid atrophy and associated diseases.

Congenital pathology in children can be treated with conservative methods. Wide swaddling or special splints can completely restore joint function. In adults, treatment for hip dislocation is more complex and lengthy; it occurs in several stages.

1. After the victim is delivered to a medical facility and diagnosed, the joint is realigned. The peculiarity of this procedure is that the hip joint is surrounded by very strong muscles, which are tense due to injury. Therefore, reduction can only be done under general anesthesia using muscle relaxants.
2. The second stage of treatment is skeletal traction. It lasts at least 3-4 weeks and is necessary in order to fix the bones in the correct position. Bed rest at this time is necessary.
3. In case of complicated dislocation with damage to the integrity of the bones, plaster is used to fix them. Often in this case, surgery is required to repair the damaged ligaments and muscles.
4. After restoring the integrity of the joint, the patient is allowed to move, but only with the help of crutches. And if the dislocation was bilateral, then this stage occurs later.
5. Very important proper rehabilitation after such an injury. Only special gymnastics and physiotherapy will help quickly restore mobility to the joint.

Therapy (reduction)

The method of treating pathology primarily depends on the amount of time lost between the occurrence of the injury and the opportunity to correct it. For the treatment of fresh injury (no more than three days) in the absence possible complications reduction is carried out in a closed manner, without additional operative (surgical) intervention.

Doctors need to repeat all changes in the position of the head only in the reverse order, since only in this case everything can fall into place without losing functionality.

In medical practice, reduction according to Kocher and Dzhanilidze is most often used. In each of them, the last correct movement of the surgeon’s hands is accompanied by a characteristic click.

After such treatment, repeat images must be taken to fully ensure that the work was done correctly.

​As for the treatment of congenital dislocation, it can be carried out both conservatively and surgically. In this case, a conservative treatment route is appropriate for early diagnosis. In such cases it can be effective and give good results.​

​Fixation of the joint with a plaster cast for up to 1 month.​

​As for the manifestations of congenital dislocation, these may be characteristic clicks that are observed in newborns when bending the leg at the hip and knee joints. This symptom should be identified from the traditional crunching sound for a baby, which is the result of the rapid growth rate of ligaments and bones, which at a certain stage may not coincide.

If this symptom, which may disappear by the second month of the child’s life, is not noticed in a timely manner, then further treatment can be very difficult and the consequences for the femoral neck can be unfavorable.

First aid

It will not be possible to carry out the reduction even if you have some experience. It will be possible to eliminate subluxation of the hip joint without anesthesia, but with complete dislocation it is impossible to do without anesthesia. The fact is that the pelvic joints are surrounded by some of the most powerful and largest muscles, which become sharply tense as a result of injury. Any manipulation will be extremely painful and will not bring the desired result.

Before the doctors arrive, you can help with pain and swelling - give an analgesic and apply ice. The entire range of measures is determined by the condition of the victim. It is easier to calm an adult than a child. Therefore, children are offered painkillers such as Nurofen or paracetamol in the form of syrup. If the damage was the result of trauma, then the lower part of the body should be immobilized as much as possible.

Even if the second leg is fine, it is better to refrain from moving independently. You can take the first steps after an injury only with the consent of your doctor. All immobilization procedures are best performed in a supine position. The leg is fixed as it was after the injury. It does not matter whether the natural joint or an artificial one is damaged - the limb is still immobilized.

Related items will help with this: ski poles, umbrellas, a mop handle, large even branches. Before fixing the splint, wrap it with a bandage or gauze. Further treatment is carried out in the traumatologist's cabin.

Of course, at the slightest suspicion of such a complex injury, you must immediately consult a doctor by calling an ambulance. After hospitalization under anesthesia, the doctor will perform a reduction of the dislocation.

In no case should you try to cope with this problem on your own, since one careless action can significantly aggravate the situation or even cause disability, but you need to provide help before the doctors arrive:

1. If you accidentally find yourself with an injured person, then before the specialists arrive, you can give him an anesthetic (if possible intramuscularly) and fix the injured limb in a motionless position. You can use available materials in the form of sticks or reinforcement, pre-wrapped with a bandage.
2. As alternative option fixation, you can tape the injured leg to the healthy one. The main thing is that during immobilization it is in the same position as immediately after the injury.
3. You can also alleviate the victim’s condition with the help of a cold compress applied to the hip joint area. An ice pack or a regular cloth soaked in cold water can be used as a cooler.
4. Having completed these manipulations, all that remains is to wait for the ambulance to arrive, because transporting the victim in a passenger car that is not equipped with everything necessary is extremely undesirable.

​sharp pain;​

The posterior one is much more common

Any form of traumatic hip dislocation is considered an emergency requiring immediate closed reduction to avoid the development of ischemic necrosis of the femoral head. Treatment should be carried out in a hospital setting under general anesthesia after the administration of muscle relaxants. If closed reduction fails, open one is performed.

First aid for a hip dislocation consists of immobilizing the affected limb and mandatory transportation to a medical facility. The joint must be realigned within 24 hours!

Should you call an ambulance?

If you suspect a hip dislocation, you should urgently call an ambulance. It will not be possible to reposition a dislocated joint on your own, since assistance is required to provide assistance. The muscles surrounding the hip joint are in a state of increased tone and will not allow the synovial surfaces to fall into place.

The ambulance doctor will give an anesthetic injection, immobilize the limb and take the patient to the nearest emergency room. If it is not possible to send the person to the hospital, he is placed on a hard board and narcotic analgesics and muscle relaxants are administered. Then the dislocated hip is reduced; if the manipulations do not bring the desired result, repositioning is performed in a medical facility.

What can you do before the doctor arrives?

Before the ambulance arrives, the victim must be placed on a flat surface and given an anesthetic tablet (Diclofenac, Nurofen). The injured limb should be secured with a bandage to the healthy leg or solid support without changing position. It cannot be straightened, bent or unbent.

Cold is applied to the hip joint area to avoid hematoma formation and severe swelling. Ice also relieves some pain. After this, you need to transport the patient to the hospital as quickly as possible, where he will have the hip dislocation reduced under anesthesia, a plaster cast will be applied, and the limb will be tractioned.

Under no circumstances should you try to straighten a dislocation yourself! This can lead to very serious consequences, from complicating the reduction of the dislocation to ruptured ligaments, tendons, and damage to the cartilage of the acetabulum. Any attempts to correct the dislocation on your own lead to an extension of the rehabilitation period.

In case of injury to the pelvic area, it is vitally important to urgently call an ambulance or the Ministry of Emergency Situations. First of all, if a hip dislocation is suspected, it is necessary to anesthetize the victim. To do this, he is administered analgesics (analgin, ketanov, or any other available) intramuscularly.

Next, it is necessary to ensure immobilization (immobility) of the injured limb. If there is a special splint available (flexible or analogs of the Dieterichs splint), it is necessary to fix the limb using the splint in the position in which it is located.

If there is no such tire, it is advisable to make its analogues from available materials - sticks, branches, any solid objects of the required size. Before application, the improvised splint is wrapped in a bandage or clothing, or clothing is placed under the splint. You can also bandage the affected limb to a healthy one with an elastic or ordinary bandage, or by any means, including the victim’s clothing.

You can put a cold compress on the projection of the hip joint.

Independent transportation of the victim is extremely undesirable. However, if there is no other way to deliver it to a healthcare facility, it must be transported on a hard surface.

Regardless of the degree of symptoms, it is necessary to consult a doctor, preferably calling an ambulance, since it is contraindicated for the patient to move on his own.

If the patient is taken to a medical facility independently, you should:

• transport in a supine position
• for severe pain, give general or local anesthesia
• fix the sore limb, tie the entire leg to the splint, or, as a last resort, tie the legs
• carry the patient on a hard surface
• if there is a bleeding wound, apply a tourniquet
• psychologically support the patient

It is possible to confirm the diagnosis using an x-ray of the hip joint and adjacent bones, which is mandatory in diagnosing the disease.

Consequences

Among the most common possible complications of the pathology, it is worth highlighting damage to the vessels that provide nutrition to the head of the femur, as well as the development of avascular necrosis with subsequent destruction of bone tissue.

The whole process, as a rule, is accompanied by severe pain and the patient’s inability to move independently. The optimal solution to this problem is endoprosthetics surgery (replacing the damaged hip joint with a prosthesis made from modern materials).

At the same time, the new replacement completely matches the damaged one in shape and size, which ensures full performance of all functions.

The second no less serious point concerns a possible bruise of the sciatic nerve located near the joint. This disease is characterized by painful sensations along the back of the leg, as well as impaired sensitivity and movement with the onset of complete paralysis of the limb (if a nerve rupture occurs).

Among the external symptoms, attention should be paid to peeling of the skin and the formation of ulcerative wounds on its surface.

If displacement of the head provokes damage to the obturator nerve, then the patient may experience muscle disorders inside hips. The sooner the hip dislocation is reduced, the sooner the patient’s full functionality will be restored.

Otherwise, the tissues cease to receive the necessary oxygen, which means their necrosis (death) begins to develop.

​There has been a fracture of the femur or pelvic bones.​

​Treatment of hip dislocations consists of urgent reduction and short-term fixation, followed by mandatory functional therapy (physiotherapy and physiotherapy).​

The consequences of this pathology can be very dangerous. Among them, the greatest health risks are:

• disruption of large vessels, which can cause necrosis of the femoral head and tissue destruction.
• bruise of the sciatic nerve, in which there are sensory disturbances, movement disorders, and severe pain;
• compression of the femoral vessels, resulting in poor circulation in the legs;
• disruption of the obturator nerve, resulting in muscle disorders.

Due to the likelihood of complications from hip dislocation, especially in children and newborns, you should consult a doctor.

As is known, as a result of dislocation, the joint capsule ruptures, which can lead to irreversible changes in the femoral head. This, in turn, becomes a serious reason for the development of coxarthrosis and degenerative changes soft tissue structures.

The possibility of cure and consequences depend on the degree of injury, the age of the injured person and the advanced stage of the disease. However, the consequences of injury include:

• impaired blood circulation in the bones and pelvis, which leads to tissue necrosis, necrosis and destruction of the bone itself
• non-fusion of fragments and formation of a false joint
• the formation of bedsores on the patient’s body, as well as vascular thrombosis as a result of the body being in one position for a long time
• pneumonia, again lack of movement, congestion in the lungs, which can result in death
• illiterate surgical intervention - tendons, nerves, blood vessels are affected, postoperative disorders
• rejection of prostheses and their metal components
• postoperative sepsis
• arthrosis, atrophy of joints and limbs

If this pathology is untimely or improperly treated, serious complications can develop. This happens if the victim did not immediately consult a doctor or did not follow all his instructions.

Due to prolonged incorrect position of the femur, the following consequences appear:

• most often arthrosis develops - destruction of cartilage tissue in the joint area;
• with incorrect or untimely reduction, necrosis of the bone head develops;
• As a result of dislocation, there may also be damage to nerves and blood vessels, ankylosis of the joint or the development of arthritis.

A hip dislocation is a fairly serious injury. Only with timely consultation with a doctor and following all his recommendations is it possible to fully restore the functions of the composition.

Rehabilitation and prognosis

If the dislocation is not complicated by fractures or damage to soft tissues, after a course of treatment the patient will fully recover. Even in the presence of complications, correct and timely therapy gives a positive result, but the risk of developing arthrosis and arthritis in the long-term prognosis increases.

Rehabilitation lasts a long period. In case of an ideal dislocation, which was reduced without surgery, bed rest is observed for 2 weeks.

When the patient has the opportunity to move, he performs physical therapy exercises. Additionally, physiotherapy and massage are prescribed. Treatment is effective only in combination.

Order of conduct complex therapy:

• Rehabilitation begins with stroking and rubbing to restore blood flow and speed up recovery. Then kneading techniques are added to the massage.
• Therapeutic exercise is the next stage of complex treatment. Exercises in the first sessions are designed to prevent muscle atrophy and improve blood flow in them. The patient then performs movements to improve mobility in the joint and restore its full function.
• Physiotherapy includes UHF and magnetic therapy.

After the rehabilitation course, the patient returns to his usual work and rest schedule. By following your doctor's recommendations, you can get rid of the consequences of hip joint dislocation. It is important to maintain an optimal activity level and take prescribed medications.

In most cases, the outcome of the injury is favorable.

The rehabilitation period lasts about 3 months. After traction, when the patient can get up, physical therapy, massage, and various physiotherapeutic procedures are prescribed. It is useful to relax by the sea and visit sanatorium-resort institutions.

Massage

Massaging the hip joint helps to relax the surrounding muscles, reduce pain, and normalize blood circulation in the affected tissues. The procedure improves the patient’s well-being, accelerates recovery, and restores limb mobility.

Massage the gluteus maximus muscles with stroking, rubbing, stroking movements.

Treatment can be performed independently or with a professional massage therapist. After surgical interventions or endoprosthetics, it is useful to do hydromassage.

Physiotherapy

Exercises aimed at strengthening the pelvic muscles are carried out 4 weeks after the reduction of the dislocation and the end of traction. Start training with a light load, then gradually increase the intensity.

In the first days, patients perform a light warm-up, isometric, static exercises; after 4 weeks, stretching is added to the main complex; the final stage is performing active movements. The course of exercise therapy lasts at least 2 months and is supervised by a specialist. Then patients are advised to regularly go for light jogging and visit the pool.

Physiotherapy

Additional aspects of treatment are aimed at accelerating tissue regeneration, stabilizing the results obtained, and preventing relapses.

The most common physical therapy methods are:

• UV irradiation;
• inductothermy;
• vibroacoustic massage;
• mud baths;
• magnetic therapy;
• laser and ultrasound exposure.

Treatment methods are selected taking into account the severity of the disease, general condition, and the presence of concomitant diseases.

The prognosis for uncomplicated hip dislocation is favorable after completion of the course therapeutic measures complete recovery occurs. With timely and complete treatment of complicated dislocations, a complete recovery is also possible, but the likelihood of degenerative joint diseases (arthritis, arthrosis) in the long-term prognosis increases.

Ed. traumatologist-orthopedist Savchenko V.R.

megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Injuries to the lower extremity are not so common in traumatological practice, which is associated with the significant volume and strength of tissue in this section. Thanks to the powerful ligamentous apparatus, the joints of the legs are reliably protected from external damaging influences. Therefore, fractures are much more common in the weakest and most loaded area - the lower third of the lower leg bones.

Hip dislocations are observed most rarely in young and mature people; in order for such an injury to occur, the strength of the muscles and tendons surrounding the joint must be overcome. The hip ligaments are normally capable of withstanding a load of about 700 kilograms, so significant force is required to damage them. And in older people, due to weakening of bone tissue, in this case an equivalent injury develops -.

Given the extent of the damage, if a dislocation occurs, patients require immediate first aid. It consists of sequential reduction, after which the limb is fixed for a while to allow the ligamentous apparatus to heal. But during this period the patient does not remain idle - within a few days a rehabilitation program begins, aimed at fully restoring the function of the joint.

Symptoms

According to the classification, there are four separate types of hip dislocation. They are characterized by different displacements of the femoral head relative to the plane of the acetabulum. In each case, the lower limb takes a special position, which often makes it possible to determine the option only by the appearance of the leg.

But all four types are united general symptoms, which are typical for the development of dislocation in any location. Their knowledge and adequate assessment will allow us to suspect this serious injury in time and provide first aid to the victim:

1. The first manifestation is always a sharp crunch or cracking sound in the hip joint. Its appearance is caused by a mechanical effect on the ligaments, which is accompanied by their multiple small tears in the area of ​​greatest pressure.
2. Then severe pain occurs in the lower limb, which at first has a diffuse aching character, and then is localized in the articulation area. Any attempt to move the leg or move it with the hands will lead to increased pain.


3. There is a relative shortening of the limb compared to a healthy leg - that is, their length differs only externally. When measured using anatomical landmarks, both legs turn out to be the same in length.
4. When palpated, the head and neck of the femur are identified in the area of ​​soft tissue surrounding the pelvis. Normally they should not be located this way.
5. Complete absence of active movements - when trying to move the leg, only increased pain is observed.
6. Finally, a symptom of spring fixation, characteristic of any dislocation. If you try to physically return the injured leg to the correct position, then when you release it, it again takes on its original appearance.

Therefore, it is necessary to provide first aid as quickly as possible and correct the dislocated hip - the symptoms are precisely related to the pathological displacement of the femoral head.

Front

These options are much less common, since the front of the hip joint is reliably protected by powerful ligaments. Therefore, its development is possible only with significant direct mechanical impact directly on the articulation area. Depending on the direction of displacement, there are two types of anterior dislocation:

• The suprapubic variant is characterized by damage predominantly to the upper part of the joint membranes. In this case, the head of the femur moves into soft tissues groin area, where it is often determined visually. There you can feel its contours through the skin. The limb, unlike other types, does not take on a special appearance, being located symmetrically with respect to the healthy leg. Only its visual shortening is noted.
• The obturator variant is characterized by damage to the ligamentous apparatus in the lower part if the impact on the joint occurred from the back or outside. The femoral head moves through the resulting defect into the area of ​​the soft tissues of the perineum and genital organs. It can be identified by touch by the lower third of the inguinal fold. With the anterior-inferior type of displacement, the leg takes on the most characteristic appearance - it is bent at the hip and knee joints and abducted outward.

Although anterior variants are quite rare, their reduction is almost always difficult, due to the risk of damage to blood vessels and nerves in the perineal area.

Rear

These types of injury occupy more than two-thirds of the overall structure - this is explained by anatomical features and typical mechanisms of injury. In the area of ​​the posterior inferior surface of the joint there is a gap that is not reinforced by tendon fibers. Therefore, through it, with a sharp and typical axial impact transmitted along the femur, the articular head moves.

Depending on its further movement, there are also two types of posterior dislocation - upper and lower. And they can also be easily distinguished from each other, focusing only on the appearance of the limb:

• Most often, the iliac variant of the injury occurs when the head of the femur moves upward after destruction of the articular capsule. Then it finds itself in the thickness of the soft tissues of the gluteal region, where a thick layer muscle tissue slows down its further movement. It is almost impossible to find it there. At the same time, the leg bends slightly at the hip joint, the thigh is adducted and rotated inward.
• The sciatic version of the injury is less common - in this case, the head of the femur carries out almost rectilinear movement through the resulting defect. Its end point of displacement is the soft tissue in the lower part of the gluteal region. It is often possible to even feel the formation through the skin. Externally, the leg is significantly bent at the hip and knee joints, adducted and rotated inward.

Despite the many options listed, first aid measures will be the same in any case - pain relief and the creation of functional rest of the affected limb.

Treatment

The sooner treatment is provided, the faster the patient’s recovery from injury will occur. All first aid is aimed at preparing for subsequent reduction - the only conservative method of treatment. It should include the following steps:

1. The first step is to create psychological peace for the patient - he should avoid any attempts to stand on the affected limb. In this case, the axial load will only increase the amount of damage to the joint membranes, which will aggravate the severity of the damage.
2. It is better if a person takes a lying position - for convenience, it is better for him to sit on his healthy side. This will eliminate additional mechanical impact during posterior dislocation.
3. Called immediately ambulance to transport the victim to the hospital.

During dislocation, doctors usually provide pain relief on site, as well as immobilization of the limb using ladder splints. It is recommended to move the patient on a stretcher, but in rare cases it is possible to move to the ambulance with full outside support - with the help of two people. They support the patient by the shoulders on each side, preventing him from stepping on the affected leg.

Reduction

Before entering the hospital, it is not recommended to try to reduce a dislocated hip on your own - treatment should only be carried out under the supervision of a doctor. In the hospital, additional anesthesia is provided, which will allow the patient to calm down and simplify the procedure. Also, reducing pain will partially eliminate muscle spasm that prevents the articular head from returning to its place.

Traumatic hip dislocation is currently reduced according to two methods. Their choice depends only on the type of injury:

• The Dzhanelidze method is used mainly for posterior types of displacement - iliac and sciatic. To begin, the patient is placed on a high couch so that the affected leg hangs freely from it for 15 minutes. This action achieves additional muscle relaxation. Then pressure is applied to the victim’s limb, bent at the knee, while rotating it slightly. Reduction is accompanied by the appearance of a characteristic click.
• The Kocher method is used only for anterior types of dislocation - suprapubic and obturator. The patient lies on his back, after which the assistant securely fixes his pelvis, pressing it. The doctor bends the affected leg at the hip and knee joint, further bringing it inward. Then he gradually pulls it towards himself, while simultaneously rotating it outward. At this point there is usually a click indicating reduction.

To ensure the correctness of treatment measures, a survey radiograph is performed, which evaluates the position of the head in relation to the acetabulum.

Fixation

Plaster casting is used extremely rarely for treatment - preference is given to indirect traction methods. They not only create functional rest for the joint, but also accelerate the healing of its membranes:

1. For a period of 3 to 4 weeks, the limb is completely immobilized - it is placed on a special Beler splint.
2. Using an adhesive plaster, tapes are fixed to the lower leg and thigh, to which small weights are attached - traction is performed.
3. After 4 weeks, the patient is gradually allowed to stand up, but avoid sitting. A dosed load is carried out - walking with crutches.
4. At the same time, the patient begins to undergo a course of active recovery - a program of physical therapy (physical therapy) is prescribed, including exercises to strengthen the thigh muscles.
5. After 14 weeks, the gentle regimen ends and the patient is allowed to fully rely on the affected limb. But for some time you are allowed to use a cane.

For the first four weeks, the victim is not inactive - he is prescribed passive physiotherapy procedures. It’s too early to talk about massage in this period, but various warming techniques have a good restorative effect.

Rehabilitation

The initial recovery period starts from the moment the dislocation is reduced and lasts until the adhesive plaster is removed. At this time, the patient undergoes various procedures aimed at accelerating the regeneration processes in the membranes of the joint:

• At first, phonophoresis is actively used with a variety of medications that have analgesic, absorbable and antispasmodic properties. Therefore, with the help of them, lidase, novocaine, calcium chloride and aminophylline are usually introduced into the tissues surrounding the joint.
• For decreasing pain syndrome Reflex techniques are also used - applications of warm paraffin and ozokerite to the area of ​​the hip joint.
• Additionally, warming and local irritating procedures are prescribed - or inductothermy, laser.
• Magnetic therapy has a good indirect effect, which affects all pathological links that impede the regeneration process.
• At the last stage, it can be used as an indirect and safe procedure with a reflex effect.

Naturally, not all of the listed methods are used simultaneously - usually the doctor chooses a combination of two or three options that are currently available.

strengthening

The basis of active rehabilitation, which begins 4 weeks after reduction, is physical therapy. Moreover, its program must necessarily have a staged nature, determining a gradual and measured increase in load:

1. Gymnastics begins with a kind of warm-up, since you cannot immediately move on to active exercises. During the first week, only the muscles of areas remote from the area of ​​injury are trained - the legs, feet, arms and shoulder girdle.
2. Then, isometric exercises for the thigh muscles are added to the patient’s program. It is necessary to repeatedly strain and relax them without making any movement in the joint.
3. The next step is to add static exercises - they provide an increase in the endurance of the muscles surrounding the hip joint. To do this, the patient must keep his legs suspended in various positions - lying, standing or sitting. Moreover, the retention time also gradually increases.
4. After three weeks of training, you can start stretching - for this, maximum dosed flexion or extension of the leg is carried out in a lying position. Then other movement options are added - adduction and abduction, inward and outward rotation.
5. Finally, the patient begins active exercise - they are mainly aimed at strengthening the muscles of the lower extremities. Moreover, the affected limb is not trained separately - it is symmetrical work that is important. The choice of the sequence of exercises is made only with the help of a specialist in physical therapy.

Active activities continue until the end of the rehabilitation period - that is, about 2 more months. Although after full recovery The training program is ending, it is better to continue to follow it for a few more months. Additionally, you can go swimming, as it has a harmonious effect on strengthening the muscles of the thigh and buttocks, and is quite safe in terms of injuries.

Posterior dislocations are the most common (up to 80% of all dislocations) hips. When a sharp flexion, adduction and internal rotation of the leg crosses the physiological boundaries, the femoral neck rests against the anterosuperior edge of the acetabulum fossa. By forming a fulcrum here, a double-armed lever is created, the short end of which—the articular head—strongly strains and tears the posterior, poorly strengthened part of the articular capsule. If the limb is bent less with increased adduction and internal rotation (rotation) right angle, the result is a dislocation with a rupture of the bursa over the tendon. When the hip is bent beyond a right angle, dislocation occurs with rupture of the bursa and the head coming out under the tendon. This position of the head can change - in the presence of ongoing violence - in the form of internal rotation (rotation) of the hip. In general, the lower the articular head is, the stronger the initial flexion and the lower the posterior capsule is torn.

Symptoms of posterior hip dislocation

When a dislocation occurs, the leg is adducted, slightly bent at the hip and knee joints, sharply twisted (rotated) inward and presents spring resistance when trying to straighten it at the hip or knee. The trochanter stands above the Roser-Nelaton line and anterior to its middle. The head of the femoral joint can be easily felt in the gluteal region in thin people. Sometimes there are disorders of the sciatic nerve (n. ischiadici) on the side of the hip dislocation.

Anterior hip dislocations

Anterior dislocation can be obtained in an experiment on a corpse with forced abduction with outward rotation (rotation) and extension. In life, these dislocations occur, for example, when falling from a height onto spread legs with the torso tilted back, the lower edge of the articular fossa serves as a fulcrum for the femoral neck, and the articular head of the femur easily breaks through the weak anterior-superior part of the articular capsule and gives an anterior hip dislocation. The articular head can then move further upward, under the lumboiliac muscle (m. Iliopsoas) or inward. With an anterior hip dislocation, the vessels and nerves pass inward from the articular head or under it and can be compressed by it.

Symptoms of anterior hip dislocation

With anterior dislocation of the hip, the leg is extended or very slightly bent, abducted, turned outward, often not shortened and, thanks to the abduction, seems even longer. The tense state of the leg does not allow active movements in it. Passive movements are slightly possible in the further direction of the changed hip positions. Under Poupart's ligament, the femoral head is either visible or easily palpable. The femoral artery should be pulsating inward from it, which may be compressed. The nerves (n. cruralis and n. saphenus) can also be compressed and cause changes in sensation in the thigh and lower leg. If the torso, when falling on the outstretched legs apart, does not lean back, but, on the contrary, the leg abducted and twisted outward (rotated) maintains a flexion position in the pelvis, then during violence the head rests on the anterior-lower part of the bag.

Due to the fixation of the trochanteric area by a strongly stretched ligament (lig. Bertini), a double-armed lever is obtained, the short arm of which (the femoral neck with the articular head) ruptures the anterior-inferior part of the bursa, becomes positioned at the foramen ovale and causes a lower anterior dislocation of the hip. Its symptoms are similar to those of upper anterior hip dislocation, but here the position of the leg is even more characteristic - sharply bent at the hip and knee joints, abducted and everted (rotated) outward. In this position the head is firmly fixed.

Greater value It also has a rather rare displacement of the femoral head - through the broken bottom of the acetabulum (acetabuli), through which the head is perforated into the pelvic cavity. This dislocation-fracture occurs either with direct force from the trochanter or with a fall on the side. Hip movements, especially abduction, are severely difficult. The lateral size from the trochanter to the midline of the body is reduced compared to the healthy side. The bottom of the acetabuli with the head of the femur, pushed into the pelvis, can be easily palpated through the rectum. An x-ray of the pelvic bones shows a sharp protrusion of the bottom of the acetabulum (acetabuli) into the pelvic cavity, the transverse size of which is reduced here.

Reduction of hip dislocation

Reducing a dislocated hip is quite a rewarding task. Even old hip dislocations 1-2 months old can be corrected. There have been cases where reduction was possible even after a year. Reduction of a dislocated hip is always best done under general anesthesia or spinal (epidural) anesthesia. Of the old methods of reducing hip dislocation, traction along the longitudinal axis was left as irrational, due to the sharp tension of the Bertinian ligament, which interferes with reduction.

When reducing posterior hip dislocations, the most popular new method is the lever method of Roiteau Despres, developed by Bigelow and based on flexion of the hip with an outward rotation. The patient lies down on the floor. The assistant firmly fixes the pelvis with both hands, and the surgeon grabs the shin with both hands. Raising his leg up, he bends the knee and hip joints at a right angle and pulls the thigh up. The ligament of Bertinius relaxes and the head is positioned at the posterior edge of the fossa. With subsequent outward rotation, the newly tightened ligament of Bertinius will serve as the fulcrum of the lever directing the head into the fossa. If reduction in this way fails, then with continuous upward traction of the bent hip, before starting abduction, it is necessary to further adduct and rotate the hip inward in order to further relax the Bertinian ligament with such a maneuver and bring the head as close as possible to the articular fossa and then quickly by rotating outward and abducting, push it into the articular fossa.

In trauma practice, a pathology such as hip dislocation is often encountered. The hip joint refers to the hip joint. It is one of the largest joints in the human body. The head of the femur and the acetabulum take part in the formation of the joint. Dislocations, like fractures, most often occur as a result of accidents (falls, landslides, transport accidents). Children are often diagnosed with congenital hip dislocation.

Features of hip dislocation

Dislocation is a displacement of bone structures, against the background of which a change in the shape of the articular surfaces occurs. If a fracture is formed by a direct blow, then a dislocation occurs due to an indirect injury. As a result, the femoral head emerges from the capsule. Often, in parallel with this, a sprain of the ligaments occurs.
Subluxation of the hip joint can be acquired or congenital. The following are distinguished: posterior and anterior dislocation. Each of them is divided into upper and lower. The reasons for this pathological condition are different. Central hip dislocation or any other can occur under the following circumstances:

• when falling from a height;
• as a result of transport accidents;
• when slipping and falling on your hips.

Dislocation is diagnosed in both children and adults. Its share in the total structure of dislocations accounts for about 5%. As for congenital dislocation, it develops as a result of dysplasia (impaired biomechanics of the joint). This is the most severe congenital pathology of the bone apparatus.

Clinical manifestations

Symptoms of a dislocation are not specific. Most patients complain of pain in the hip area. Most often it is one-sided. The pain is sharp. It intensifies when trying to carry out movement.
Others possible signs are:

• shortening of the affected limb;
• joint deformity;
• forced position of the patient;
• restriction of physical activity.

If a child or adult has a posterior dislocation, the affected limb is adducted and the knee is rotated inward. The leg is bent. In the case of anterior dislocation, abduction of the leg is observed. It is turned outward. During the medical examination, the femoral head can be felt in the area of ​​the ischium or buttocks. With lower and posterior injuries, the joint may be injured sciatic nerve. In this case, the patient is bothered by constant pain. There are many blood vessels located in front of the joint.
If a traumatic impact occurs in this area, the femoral vessels may be compressed. Not all people who suffer such an injury seek medical help. Over time, the dislocation goes away. The length of the limb gradually returns to its original value. This occurs due to changes in the position of the pelvis and an increase in the lumbar curvature of the spinal column.

Dislocation at birth

Symptoms of such a disease may appear in a child some time after birth. This pathology is diagnosed more often in girls than in boys. Unlike adults, in this situation the process more often affects both hip joints. This defect is associated with a violation of the formation of joints during the formation of tissues. Dislocation in children can be caused by an abnormal shape of the socket or head of the femur, as well as the femoral neck. The surface ratio may be disrupted or it may remain within normal limits.
Causes of this condition include:

• toxic effects on the fetus of various substances;
• diseases of a pregnant woman;
• injuries;
• harmful occupational factors;
• bad environment.

An experienced pediatrician knows the main signs of congenital hip dislocation in children. The main ones are:

• shortening of the limb;
• asymmetry of skin folds in the leg area;
• violation of abduction of the lower extremities.

This congenital pathology may not be detected immediately. In children 1 year of age and older, additional signs of dislocation may be present. These include gait disturbances and abnormal alignment of the greater trochanter of the femur. In children, such a defect often leads to lateral curvature of the spinal column (scoliosis). Such children begin to walk at a later age.

Diagnostic measures

The main method for detecting hip dislocation in children and adults is ultrasound and x-ray examination. A medical examination is of no small importance in making a diagnosis. Visually, in such patients, it is possible to determine the shortening of one limb and identify joint deformity. X-ray examination should be carried out in 2 projections (direct and lateral).
This study allows you to assess the condition of the joint and the degree of displacement of bone structures. In addition, it can be used to identify concomitant fractures of the femur and pelvis.
In case of doubt, an additional MRI may be prescribed. If found in a child, you need to contact a pediatric orthopedist. Diagnosis should be carried out in the first 3 months after the birth of the baby. If the diagnosis is made later, such diagnosis is delayed.

Treatment of hip dislocation

For hip dislocation, treatment can be conservative or surgical. The first option is relevant for timely diagnosis. A special tire is selected for small children. It is applied in order to correctly shape the position of the hip joints.
The lower limbs should be bent at the hips and knee joints at a certain angle. In this position, the head of the femur will gradually be reduced. It is best to carry out such treatment in the first days of the baby’s life. The later treatment is started, the worse the conditions will be for the subsequent normal development of the joint.
Much attention should be paid to caring for such babies. Infants should be swaddled widely so that their legs are not pressed together. It is advisable to use disposable diapers. The doctor may prescribe massage and therapeutic exercises. If there is already a dislocation for a long time, surgical treatment may be performed.

In adults, treatment involves repositioning the femoral head and fixing it.

The reduction is carried out by a doctor in a hospital setting. Reduction with anesthesia can be carried out in two ways: according to Dzhanelidze and Kocher. In the case of superior anterior dislocation, the Dzhanelidze method is not used due to the risk of femoral neck fracture.
The next stage of treatment after reduction is skeletal traction. Its duration varies from 3 to 4 weeks. Upon completion, the patient must move with the help of crutches. The rehabilitation period is also very important for a speedy recovery. In this situation, physiotherapy and therapeutic exercises are prescribed. If diagnosis and treatment are not timely, coxarthrosis may develop. It is characterized by the destruction of cartilage tissue. In case of severe coxarthrosis, endoprosthetics may be required (replacement