Hip Injury
Basics
Description
Description
- Hip injury includes hip fractures and dislocations of the proximal femur due to minor or major trauma, or overuse
- Hip fracture: Fracture of proximal femur. Classified as intracapsular or extracapsular
- Intracapsular fracture: Femoral head or neck; often associated with disruption of femoral neck vessels; significant morbidity due to AVN and higher rate of malunion:
- Femoral head fracture: Usually associated with hip dislocation (anterior > posterior)
- Femoral neck fracture: Usually older adults with minor trauma, or young patient with major trauma. Patient may or may not be ambulatory. Often site of stress fracture in runners
- Extracapsular fractures: Below acetabular capsule to the distal lesser trochanter. Normally do not disrupt blood flow. Morbidity typically due to patient immobilization, DVT, PE:
- Trochanteric fractures: Greater trochanter usually fractured by avulsion at the site of insertion of the gluteus medius. Lesser trochanter usually fractured by avulsion from forceful contraction of iliopsoas; seen in young athletes and children
- Intertrochanteric fracture: In line between greater and lesser trochanters. Common in elderly and osteoporotic patients secondary to fall. External rotation and shortening. Can be stable or unstable. Nonambulatory
- Subtrochanteric fracture: Usually due to direct, major trauma in younger patients or lesser trauma in elderly. Common site of pathologic fracture. Can result in significant blood loss and shock
- Intracapsular fracture: Femoral head or neck; often associated with disruption of femoral neck vessels; significant morbidity due to AVN and higher rate of malunion:
- Hip dislocation: Disarticulation of femoral head. Classified as posterior, anterior, and central:
- Posterior dislocation (most common):
- Often from motor vehicle accident (MVA) in which knees strike dashboard
- 10% associated with sciatic nerve injury
- Anterior dislocation:
- Often due to trauma with sudden abduction of thigh
- Associated femoral head fractures, femoral nerve injury
- Can be anterior superior or anterior inferior
- Central dislocation with acetabular fracture:
- Usually from direct impact to greater trochanter
- Associated with significant blood loss, sciatic nerve injury
- Posterior dislocation (most common):
Pediatric Considerations
- Hip dislocation: Uncommon; often spontaneously reduced at time of injury. Concern for tissue trapped in joint space:
- Trivial force required for posterior hip dislocations in children <10 yr old
- Proximal femoral physeal fracture: Fracture at growth plate; high risk for osseous necrosis
- Slipped capital femoral epiphysis: Displacement between the femoral neck and capital femoral epiphysis. Typically in obese children
- Femoral neck fractures: Relatively common; stress fractures in young athletes
- Intertrochanteric fractures: Rare
- Consider pathologic fracture with minor trauma
Etiology
Etiology
See individual injuries above
There's more to see -- the rest of this topic is available only to subscribers.
Citation
Schaider, Jeffrey J., et al., editors. "Hip Injury." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307359/2.3/Hip_Injury.
Hip Injury. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307359/2.3/Hip_Injury. Accessed December 7, 2024.
Hip Injury. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307359/2.3/Hip_Injury
Hip Injury [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 07]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307359/2.3/Hip_Injury.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Hip Injury
ID - 307359
ED - Barkin,Adam Z,
ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307359/2.3/Hip_Injury
PB - Lippincott Williams & Wilkins
ET - 6
DB - Emergency Central
DP - Unbound Medicine
ER -