Fracture and Dislocation of the Hip

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Hip fractures are breaks in the femur (thigh bone) near the hip joint, while hip dislocations occur when the femoral head is displaced from the acetabulum. Both conditions are serious and often require immediate medical attention.

Aetiology

Fractures and dislocations of the hip can be caused by:

• Trauma, such as falls, car accidents, or sports injuries
• Osteoporosis, which weakens bones and makes them more susceptible to fractures
• Pathological fractures due to bone diseases like cancer
• High-impact activities or accidents

Pathophysiology

The pathophysiology of hip fractures and dislocations involves:

• Disruption of the normal architecture of the hip joint
• Damage to surrounding muscles, ligaments, and blood vessels
• Potential compromise of blood supply to the femoral head, leading to avascular necrosis
• Inflammation and haemorrhage within the joint capsule

Risk Factors

• Advanced age
• Osteoporosis or other bone-weakening conditions
• High-risk activities or sports
• History of previous fractures or dislocations
• Neuromuscular conditions that affect balance and coordination
• Medications that affect bone density or balance

Signs and Symptoms

The signs and symptoms of hip fractures and dislocations include:

• Severe pain in the hip or groin
• Inability to move the leg or bear weight on it
• Shortened and externally rotated leg in cases of hip fracture
• Visible deformity or asymmetry in the hip area
• Swelling and bruising around the hip
• Loss of normal hip function

Investigations

Specific investigations to diagnose hip fractures and dislocations include:

• Clinical examination: Physical assessment of pain, deformity, and range of motion.
• Imaging studies:
  • X-rays: To confirm the presence and type of fracture or dislocation.
  • CT scan: For detailed images of complex fractures or associated injuries.
  • MRI: To evaluate soft tissue damage and blood supply to the femoral head.
• Blood tests: To assess overall health and pre-surgical fitness, if surgery is needed.

Management

Primary Care Management

• Initial assessment and stabilisation: Prompt referral to emergency services for further evaluation and treatment.
• Pain management: Analgesics such as paracetamol or NSAIDs to relieve pain.
• Immobilisation: Splinting or using a sling to stabilise the hip joint temporarily.

Specialist Management

• Closed reduction: Manipulative reduction of dislocated hip joints under sedation or anaesthesia.
• Surgical intervention:
  • Internal fixation: Using screws, plates, or rods to stabilise the fracture.
  • Hip replacement: Partial or total replacement of the hip joint in cases of severe fractures.
• Postoperative care: Pain management, physiotherapy, and rehabilitation to restore hip function.
• Monitoring for complications: Regular follow-up to detect and manage potential complications such as avascular necrosis or infection.

References

1. NHS (2024) Hip fracture. Available at: https://www.nhs.uk/conditions/hip-fracture/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Hip fracture: management. Available at: https://www.nice.org.uk/guidance/ng38 (Accessed: 24 June 2024).
3. British Medical Journal (2024) Hip fractures: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/350/bmj.h2407 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Hip Fractures in Adults. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/hip-fractures-in-adults/ (Accessed: 24 June 2024).

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