Hip Dislocations - Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing hip dislocations and their treatment.
Hip dislocation cab be either a simple dislocation or it can be a fracture dislocation which involves the posterior wall of the acetabulum or the femoral head.
Dislocation of the hip can be two types:
1.Posterior dislocation (most common type)
2.Anterior dislocation (rare)
Position of the hip during the impact decides the injury.
In posterior dislocation of the hip, which is the most common type, the lower limb will be flexed, adducted and internally rotated.
Hip fractures are different than hip dislocations. Notice that the affected extremity is shortened and externally rotated with a hip fracture.
Hip dislocation of any type is an emergency. It must be reduced in less than 6 hours of injury. After reduction of the hip, get a CT scan. A CT scan clearly outlines the bony injury. Check the CT scan for congruous reduction, for the absence of fracture and absence of marginal impaction in the acetabulum. Marginal impaction is more common in posterior acetabular wall fractures and could lead to instability.
Displaced or comminuted posterior wall fracture could lead to arthritis. Make sure that you have a congruous reduction with no loose bodies or important fractures present. Check for fractures of the acetabulum and the size of the fragment. The size of the posterior wall fracture has an effect on the stability of the hip joint. If congruous reduction of the hip is not obtained, perform open reduction urgently. Open reduction can be done through an anterior approach or a posterior approach.
Hip dislocation with or without associated fracture can cause complications.The risk of avascular necrosis depends on the interval between the injury and reduction of the dislocation. Urgent reduction of hip dislocation is mandatory to avoid AVN and interruption of the blood supply which leads to collapse of the femoral head. Closed reduction should be done in less than 6 hours.
When injury occurs to the sciatic nerve due to posterior hip dislocation, the common peroneal nerve is usually affected, causing weakness in dorsiflexion of the ankle and loss of toe extension.
Injury to the sciatic nerve usually occurs from the dislocation and not from the reduction of the hip. The longer the wait for the reduction of the dislocation, the more the patient is predisposed to sciatic nerve injury. The length of time a hip remains dislocated influences the incidence and the severity of a major sciatic nerve injury.
Neurological examination at the time of injury is usually difficult, however it is extremely necessary. Check for sensation on the top of the foot.
In posterior dislocation of the hip, always look for injuries in the knee such as dashboard injury. The force of the injury is usually transmitted from the knee to the hip.
In cases of high energy trauma, always look at the chest. There might be a tear of the aorta. Check for widening of the mediastinum on chest x-rays. There is concern of deceleration injury involving the aorta.
Hip joint dislocation may be associated with acetabular fracture or fracture of the femoral head (Pipkin fracture). With Pipkin fracture, as the femoral head dislocated, it hits the posterior wall of the acetabulum and the femoral head fractures. This may be different from an anterior hip dislocation. Anterior hip dislocation will cause impaction of the femoral head or indentation fractures. Classically, Pipkin fracture is a posterior fracture dislocation of the hip and fracture of the femoral head.
Treatment of hip dislocation
•Emergency closed reduction of the hip within 6 hours.
•Closed reduction is done to avoid AVN of the hip.
•Reduction of the hip joint and mobilization of the patient with protected weight-bearing crutches for 4-6 weeks.
•After closed reduction, when the patient has an associated fracture, assess the ip stability
•The hip is usually stable if the fragment size of the acetabulum is less than 20% •More than 40 %, the hip is unstable. •Between 20-40% fragment size, the hip stability is undetermined.
When there is an associated acetabular fracture, the best method to assess the stability of the hip is by examination of the patient under general anesthesia utilizing fluoroscopy.
Assess the posterior wall stability with the obturator oblique view. Hip will be in flexion, adduction and add axial load. Check the medial clear space for opening.
Irreducible isolated posterior dislocation
•Do emergency surgical treatment to reduce the hip.
Treatment of posterior hip dislocation with posterior acetabular wall fracture
•Must assess the stability of the hip joint by examination under anesthesia after closed reduction.
•After closed reduction, if the dislocation is not congruent, do open reduction and fixation urgently.
Treatment of Pipkin femoral head fractures
•Headless screw fixation.

[@Walid0001-d3x]

13 years later and this video is still helping so many med students and saving lives

[@funwithyoutubeee3164]

Thank you so much for all your hard work into doing these amazing videos!! They are incredibly informative and the images provided are so helpful!!

[@hasanmohammad9520]

Awsome demonstration. I'm wondering; who doesn't like this video..??!!

[@nabilebraheim]

Thank you, spread the word!!

[@bridgetcat1]

Thank You So Much For This Video - It Was Extremely Helpful To Me

[@JuanPablo-it1ll]

Thanks doc it helped me a lot for my class

[@dr.issaali2412]

you are the best dr. nabil i learn alot from you

[@mostafahossain6791]

sir ,your videos are so nice , informative and short ..I like it, continue--

[@nabilebraheim]

USE pain-relieving position THANK YOU

[@marryenni]

Very clear & informative video.thanks

[@R0V3Rvids]

More likes for no dislikes :) Great work sir.

[@jinnanfamily]

Thanks for video dislokasi sendi paha is good klimaks..

[@nabilebraheim]

Thank you.

[@abdelhady4481]

excellent video!!

[@nabilebraheim]

THANKS

[@marylynu4236]

This was so helpful!! Thanks

[@هبهمجيد-ص6ج]

thank you so much doctor..it's very scientific video 🌸

[@nabilebraheim]

@iloveflowerbeetles you need to see an ortho surgeon if you leg is short ,it will affec t your back

[@DrYoUsUF1]

thank you Dr.Nabil

[@roselineabia9513]

A good one..

[@truth-fz9lj]

thanx for this video ....... very helpful :D

[@apolospetertai6506]

thank you

[@thudson99]

Nice video! Now I am confident I don't have a hip dislocation. But my left hip is still in pain. It's been a few days now and it's not going away. I am not comfortable in any position. Still searching for answers. No medical insurance. Self diagnosis.

[@Kyash108]

thudson99 i too have left hip pain.. after doing so much heavy deadlift in the gym... Its not hip dislocation.. but hip starts paining whenever i bend myself.. if im standing straight I'm fully alright but i bend a little the pain kills me.. while laying on bed I'm alright not fully but better

[@doctorcleopatracassar9436]

great job !

[@RoliDixitunique]

Nice video.

[@NavneetKaur-wp3qc]

What are the precautions should take after hip dislocation during exercises?

[@cynthiareadinger7281]

My doc said after my car accident, don't cross my legs, don't bend beyond 90 degrees, and make sure my foot doesn't point inward, it will twist that joint. Just what I was told by my therapist.

[@miguelsobrevilla7673]

Thanks Doc.

[@andrewrcoggins]

good job

[@EllhaDavid]

hello doctor. I would like to know what the correct position to transport a patient with hip dislocation. Is it correct to force him/her to lie straight for the transport even if his/her choosen pain-relieving position is seated? Thank you and compliments for your video.

[@timestax]

Thank you. I have always blamed my AVN on steroids for 5 years. Now I wonder if the 25 to 30 right hip dislocations (averaging ever 8 days). I finally had a 3rd surgery with a ring behind the ball, it lasted 3 months before it dislocated). The 5th surgery surgeon used a larger ring. All the dislocations happened within 10 or 11 months.

[@mawaddashaban477]

Thank u so much 👍

[@toe_tag_9766]

What does it mean when right hip pops when rotating leg?

[@sukhsandhu8800]

How mays days does person had to take bed rest after hip dislocation

[@atifmusa8843]

Hello Doctor Nabil...i hope you are doing fine sir... Sir during a road accident..i dislocated my hip posteriorly..since i was on a hill station..it took 2 hours to reach a nearby hospital...and further 5 hours for an orthopaedic to reach the hospital...they attempted reduction with sedation...but no result..so i was given GA and hip was reduced...the xrays showed no fractures and my Doc said it was type 1 dislocation,..my hip was in traction for a month...its been 50 days..iv started physio

[@noodlesflawed4800]

I sustained 5 green fractures in my pelvis after a MBA and both legs felt detached. I could feel the broken bits crunching and grinding together. The hospital (Western Australia) said they should pin it but I would be liable for the cost so did nothing. The bones started to mend when the nurses tried to roll me and broke the pelvic again. it healed again crooked and now my right leg is an inch and a half shorter. I've been discredited by every doctor since who don't want to go near it. problem is I also have a prolapse disc lower lumbar and am in total agony every waking hour as the pelvic issue impacts directly on the ruptured disc (work related). life is grim...

[@banphrionsamary9713]

amazing

[@nabilebraheim]

@TCMAUMEE thanks

[@nabilebraheim]

@iloveflowerbeetles thanks

[@VtCountrygirl802]

I am currently 21 years old and am facing this in a few weeks. I have an extremely bad version of this, was told also that I have broken my femur in 3 places. I am still working and walking with a crutch due to me just finding out about this yesterday. I fall alot and my foot and leg go numb and I know within the hour I will fall.

[@haidermohammed6969]

Thank u

[@Hope-xo4sq]

والله انك فله شكرا ع الشرح

[@nabilebraheim]

GET AN XRAY MAKE SURE THAT YOU DO NOT HAVE ARTHRITIS AND CONSULT AN ORTHO SURGEON

[@niss2nice]

nabil ebraheim god bless you brother. Continue the good work

[@thudson99]

I will look into financial assistance through St. Joseph, but otherwise can't. I did get some relief from some yoga stretches/exercises for about a day. I think I caused the pain to reoccur by aggravating it somehow. Not sure what I did. Gotta figure it out.

[@nabilebraheim]

@Nickliu2010 great

[@atifmusa8843]

but sir i still feel instability..as if my thigh and pelvic muscles are unstable and my pelvic and lower back tilts...my left leg seems longer.and ders a limp in my gait..sir how long will it take to be back in sports and i hope there will be no complications..i tensed bcoz i have other problems with my shoulder n upper back..which i will discuss with u later on...

[@nabilebraheim]

@dhx9 THANKS

[@nudjumulalfiah6990]

What happen if someone has hip dislocation for 2 years ?

[@chinafox1]

Nice video! how long should the patient lie in bed after the reduction of a hip dislocation?

[@nabilebraheim]

@pawan001k thanks

[@ragnaringimar8681]

I have always since i was a child been able to move a bone fromnthe inside of my hip innand out. I can do it more on my right side because ive done it more on that side. I went to the doctor today and he had never seen anything like this before :(

[@timestax]

Do you have Ehlors-Danlos Syndrome? My DIL can pop her joints back into place also.

[@nabilebraheim]

@DrYoUsUF1 thanks

[@drmam17]

great

[@nabilebraheim]

@iloveflowerbeetles SEE AN ORTHO SURGEON USE A SHOE LIFT .IMPROVE YOUR GATE AND POSTURE

[@nabilebraheim]

@drmam17 thanks

[@Jajajajajajajajajjajaa]

0:08 femur: i hate my job

[@nabilebraheim]

@chinafox1 THANKS

[@danuskovskyGt]

What happens when you are dislocated continuously :(

[@Abdul-Y]

That indicates decreased stability of the hip joint, may be due to acetabular fracture, check with an orthopedic surgeon for evaluation. You might be adviced for specific strengthening exercises.

[@elvispresley9634]

im looking this up becuase my hip and femur keeps poping in and out of place and it hurts when it does that so i dont do alot of things becuase of my leg that keep doing it if you have any info on what it is please reply and dont say its double jointed trust me its not but if you do have any thing please please please reply, thank you.

[@PhuckHue2]

You have to stop eating so many peanut butter banana bacon sammiches. Thank you very much

[@nabilebraheim]

@chinafox1 IF THE HIOP IS STABLE THE PATIENT SHOULD BE OUT OF BED

[@jcsaenz7645]

so what if they waited longer than the 8 hours. .....and now they just go about there business like its just a part of life? can it still be repositioned?

[@Abdul-Y]

Time is of the essence in dislocations. Delay in reduction may lead to swelling and muscle spasm, which make the reduction more challenging. Also the longer the duration of dislocation, the longer the sciatic nerve compression.

[@jessetanko1973]

@@Abdul-Y And also prevent a vascular necrosis and ALSO ATHRITIS

[@JavDSilva]

Got hit by a car flew above it , broke the windshield if the car and hit the ground and the only notorius injury beside bruising and scratches was this. Worst pain ever... Was so recent that im still un bed

[@randyaimable1340]

same here... was in a similar accident 3 weeks ago but i didnt break the the windscreen but flew all the way over it and landed on my side... still in bed as well from hip dislocation

[@19781978197819781971]

هو مش ممكن تترجم الفيديو للغة العربية للفائدة خاصة وانك عربي اصلا

[@sarataha3197]

هو بيشرح طب اللى هو بيتدرس اصلا بالانجلش

[@1987xmen]

thank u(:

[@mashleyden]

Pffft. “Emergency”. Dude I got EDS, this happens atleast twice a day

[@nabilebraheim]

YOUUST SEE A DOC

[@isaacmacedo6786]

I dislocated my hip

[@isaacmacedo6786]

and fractured my pelvic bone

[@hemantrajput7080]

sir my name is hemant and 22year sir muy hip joint dislocated and time 6monthe sir my hip joint clasium problem so sir can u help me

[@anneb8292]

hemant rajput what do you mean by calcium problem?

[@xlivexforeverx1646]

i came here to learn how to dislocate my hip not learn to fix it

[@ariannawelch2115]

why do you want to dislocate your hip

[@AJAYALEN11]

Drugs. That's why.

[@reenajain9393]

Hindi m samjhae pls

[@toqaqutaiba8944]

💙💙💙💙💙

[@marryenni]

Very clear & informative video.thanks

[@nabilebraheim]

THANK YOU

[@hadibeaini9829]

Thank you!