Hip dislocations - violation of a relative positioning of a head of a femur and a vertluzhny hollow. As a rule, damage results from considerable high-speed application of the injuring force: at the road accidents, falling from height, collapses etc. Dislocation of a hip is followed by sharp pain, deformation of a coxofemoral joint and restriction of movements, shortening of an extremity on the struck party. For specification of the diagnosis the X-ray analysis or MRT coxofemoral a joint can be appointed. Treatment of dislocations of a hip comes down to their reposition and fixing of a joint for up to 1 month. In a phase of restoration LFK, physiotherapy and massage are actively applied.
Dislocations of a hip make about 5% of total of dislocations. As a rule, damage results from considerable high-speed application of the injuring force: at the road accidents, falling from height, collapses, etc.
The coxofemoral joint is formed by a convex head of a femur and a concave surface of a vertluzhny hollow of a pelvic bone. The head of a femur enters a vertluzhny hollow on 2/3. The area of a coxofemoral joint increases at the expense of the hryashcheobrazny fabric located on edge of a vertluzhny hollow. The joint is kept by the capsule and powerful sheaves.
In traumatology allocate forward and back dislocations of a hip. Forward dislocations, in turn, are subdivided on peredneverkhny (nadlonny) and perednenizhny (locking), and back – on zadneverkhny (podvzdoshny) and zadnenizhny (sciatic).
Back dislocations of a hip meet approximately by 5 times more often of lobbies.
- and – zadneverkhny dislocation
- – zadnenizhny dislocation
- in – peredneverkhny dislocation
- – perednenizhny dislocation
Dislocations of a hip result from an indirect trauma. At the same time the femur acts as the lever influencing area of a coxofemoral joint. As a result of intensive influence the head of a femur breaks off the joint capsule, injures sheaves and leaves an articulate hollow. The road trauma becomes the reason of back dislocation of a hip usually. The mechanism of traumatic influence – sharp rotation or bending of the turned knutra given and the bent leg. Forward dislocation of a hip arises when falling from height on the leg turned knaruzh, taken away and bent more often.
The patient shows complaints to sharp pain in a coxofemoral joint. The compelled position of an extremity, deformation of a coxofemoral joint, more or less expressed shortening of an extremity on the party of damage is characteristic of all types of dislocations of a hip. The passive movements in a coxofemoral joint are painful, sharply limited, are followed by the springing resistance. The active movements are impossible.
The compelled position of an extremity is defined by a femur head arrangement in relation to a vertluzhny hollow. At back dislocations the leg of the patient is brought, bent and turned by a knee inside. At zadnenizhny dislocation of a hip deformation of a coxofemoral joint is expressed more, than at zadneverkhny.
At forward dislocation the extremity of the patient is developed knaruzh, taken aside, bent in coxofemoral and knee joints. Perednenizhny dislocation is followed by more expressed bending and assignment of a leg. At zadneverkhny dislocation of a hip the head of a femur is palpated under muscles of buttocks, at zadnenizhny – near a sciatic bone.
Flattening of buttock area is characteristic of peredneverkhny dislocation. The head of a femur is palpated in the field of an inguinal fold, a knaruzha from a femoral artery. Perednenizhny dislocation is also followed by flattening of area of a buttock. The head is probed knutr from a femoral artery.
Dislocations of a hip can be followed by a separation of edge of a vertluzhny hollow and injury of a cartilage of a head of a femur. At zadnenizhny dislocations of a hip the bruise of a sciatic nerve is quite often observed. At forward dislocations of a hip perhaps sdavleny femoral vessels, at perednenizhny – injury of a locking nerve.
Stale and chronic dislocations of a hip are followed by less expressed clinical symptomatology. Pains in a joint decrease over time. Shortening and deformation of an extremity are compensated for the account of an inclination of a basin and sharp increase in a lordoz (a lumbar bend) of a backbone.
Diagnosis of dislocations of a hip, as a rule, does not cause difficulties in the traumatologist. For specification of provision of a head of a femur and an exception of possible bone damages the radiological research in two projections or MRT of a coxofemoral joint is conducted.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Treatment of dislocations of a hip consists in urgent reposition and short fixing which obligatory functional therapy follows (physiotherapy and remedial gymnastics). Traumatic dislocation of a hip is followed by reflex reduction of powerful muscles of a hip and buttock area. For successful reposition it is necessary to relax effectively these muscles therefore reposition of dislocation of a hip is made in the conditions of a hospital under the general anesthesia with application of miorelaksant.
At reposition of fresh perednenizhny, zadnenizhny and zadneverny dislocations of a hip Dzhanelidze's way is used, at reposition of chronic and fresh peredneverkhny dislocations – Kokher's way. At peredneverkhny dislocations of a hip Dzhanelidze's way is not applied as there is a danger in the course of reposition to break a femur neck. After reposition skeletal extension for a period of 3-4 weeks is imposed. Then to the patient recommend to go on crutches within 10 weeks, appoint physical therapy and remedial gymnastics.
Injury of a cartilage of a head of a femur at hip dislocation often leads to development of the deforming arthrosis of a coxofemoral joint (coxarthrosis) in the remote period. In such cases at the expressed development of violations in a joint endoprosthesis replacement of a coxofemoral joint - its removal and installation of an artificial limb can be required.