Hip Injury is a topic covered in the 5-Minute Emergency Consult.

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Basics

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:
      • 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; symptoms vary. Patient may or may not be ambulatory. Often site of stress fracture in runners/military recruits.
    • Extracapsular fractures: Below acetabular capsule. Normally do not disrupt blood flow. Morbidity typically due to patient immobilization: DVT, PE:
      • Trochanteric fractures: Greater trochanter usuallyfractured by avulsed at insertion in gluteus medius. Lesser trochanter usually fractured by avulsed from forceful contraction of iliopsoas; seen in young athletes and children.
      • Intertrochanteric fracture: Defined as occurring in line between greater and lesser trochanters. Common in elderly, osteoporosis patients often due to fall. Marked external rotation and shortening. Can be stable or unstable. Nonambulatory.
      • Subtrochanteric fracture: Usually due to direct, significant trauma in younger patients or lesser trauma in elderly. Common site of pathologic fracture. Can be site of significant blood loss and shock.
  • 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: 10% hip dislocations:
      • 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 significant blood loss, sciatic nerve injury

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 locations in children <10 yr old
  • Proximal femoral physeal fracture: Fracture at growth plate; great risk for osseous necrosis
  • Slipped capital femoral epiphysis: Minimal trauma, decreased ROM.
  • Femoral neck fractures: Relatively common; stress fractures in young athletes
  • Intertrochanteric fractures: Rare.
  • Must suspect nonaccidental trauma (NAT)
  • Consider pathologic fracture with minor trauma.

Etiology

See individual injuries above.

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Citation

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TY - ELEC T1 - Hip Injury ID - 307359 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307359/all/Hip_Injury ER -