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Fracture dislocation of hip joint — Clinical Guidelines

Overview

Fracture dislocation of the hip joint involves a complex injury characterized by both dislocation and associated fractures, often resulting from high-energy trauma. These injuries are particularly challenging due to their rarity and the need for precise management to prevent long-term complications 1.

Diagnosis

Radiographic Evaluation: Essential for confirming dislocation and identifying associated fractures 1.

Imaging Techniques: X-rays are primary, with CT scans often used for detailed fracture assessment 1 7.

Clinical Presentation: Significant pain, limited mobility, and deformity in the affected hip 1.

Management

Urgent Reduction: Closed reduction under sedation is often the first-line approach 1 8.

Sedation Methods:

- Conscious Sedation: Commonly used with propofol or benzodiazepine/opioid combinations 2 5 8. - Etomidate: Emerging as an alternative for facilitating reduction 9.

Anesthesia Considerations: Primary conscious sedation (PCS) versus primary general anesthesia (PGA) debated; outcomes vary 4.

Post-Reduction Care: Immobilization with skeletal traction or a hip spica cast, followed by rehabilitation 1 7.

Special Populations

Pediatrics: Voluntary dislocation rare but reported; conservative management possible 13.

Elderly: Higher risk of complications; careful sedation dosing advised 6.

Comorbidities: ASA grade impacts complication rates; higher grades correlate with increased risks 6.

Key Recommendations

Urgent Radiographic Assessment for diagnosis and planning reduction 1.

Use of Conscious Sedation for reduction procedures, with propofol or benzodiazepine/opioid combinations preferred 2 5 8.

Consider Patient ASA Grade to tailor sedation and anticipate complication risks 6.

Post-Reduction Immobilization with appropriate casting or traction to ensure proper healing 1 7.

(Evidence: Moderate)

Evaluate for Associated Fractures with CT scans when necessary for comprehensive management 7.

(Evidence: Moderate)

References

1 Anjum R, Ravi S, Singh G, Motten T, Vajpayee D, Thakur A. Inferior hip dislocation following mudslide impact: a unique occupational injury. BMJ case reports 2025. link 2 Ryan SP, Hopkins TJ, Wellman SS, Jiranek WA, Bolognesi MP, Seyler TM. Undersedation During Total Hip Arthroplasty Reduction Results in Worse Patient Outcomes. The Journal of arthroplasty 2019. link 3 Ayeni OR. Editorial Commentary: Safe Innovation? Arthroscopy After Traumatic Hip Dislocation. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2018. link 4 Bommiasamy AK, Opel D, McCallum R, Yonge JD, Perl VU, Connelly CR et al.. Conscious sedation versus rapid sequence intubation for the reduction of native traumatic hip dislocation. American journal of surgery 2018. link 5 Dela Cruz JE, Sullivan DN, Varboncouer E, Milbrandt JC, Duong M, Burdette S et al.. Comparison of procedural sedation for the reduction of dislocated total hip arthroplasty. The western journal of emergency medicine 2014. link 6 Dawson N, Dewar A, Gray A, Leal A. Association between ASA grade and complication rate in patients receiving procedural sedation for relocation of dislocated hip prostheses in a UK emergency department. Emergency medicine journal : EMJ 2014. link 7 Old AB, McGrory BJ, Peterson CA, Lebar RD, Goudreau FS. Locked inferior fracture dislocation after total hip arthroplasty. The Journal of arthroplasty 2008. link 8 Frymann SJ, Cumberbatch GL, Stearman AS. Reduction of dislocated hip prosthesis in the emergency department using conscious sedation: a prospective study. Emergency medicine journal : EMJ 2005. link 9 Dursteler BB, Wightman JM. Etomidate-facilitated hip reduction in the emergency department. The American journal of emergency medicine 2000. link90022-6) 10 Nadkarni JB. Simultaneous anterior and posterior dislocation of hip (a case report). Journal of postgraduate medicine 1991. link 11 Kinnard P, Lirette R. Bilateral central dislocation of the hip: a case report. Canadian journal of surgery. Journal canadien de chirurgie 1991. link 12 Fabry G, Lokietek W, Peeters M, Uyttendaele D, Legaye J. Proposal for a plan of treatment of congenital dislocation of the hip (Belgian Association of Pediatric Orthopaedics). Acta orthopaedica Belgica 1990. link 13 Iwamoto Y, Katsuki I, Eguchi M, Oishi T, Sugioka Y, Sasaki K. Voluntary dislocation of both hips in a child. A case report. International orthopaedics 1989. link 14 Ganel A, Blankstein A. Subluxation and dislocation of hip joint in femoral elongation. Orthopaedic review 1987. link 15 Katz JF. Teratological hip dislocation. Israel journal of medical sciences 1980. link 16 Scadden WJ, Dennyson WG. Unreduced obturator dislocation of the hip. A case report. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1978. link

Fracture dislocation of hip joint

Overview

Diagnosis

Management

Special Populations

Key Recommendations

References

Original source