Field Assessment & Treatment of Posterior Hip Dislocations

Pathophysiology
While posterior hip dislocations are somewhat common in head-on motor vehicle accidents and occasionally occur in elderly people with prosthetic hip joints during a minor slip or fall, they are quite rare in a wilderness environment. Most posterior hip dislocations require a significant traumatic MOI and many patients die from internal injuries to the pelvis, abdomen, chest, and head. Greater than 50% of patients have long-term disability after reduction. The femoral head is highly vascular and may die if not quickly reduced. Posterior hip dislocations are increasing along with the popularity of extreme sports; one study indicated that snowboarders were more likely to suffer a posterior hip dislocation than skiers.

The hip joint is a ball-and-socket synovial joint: the ball is the femoral head, and the socket is the acetabulum. The adult hip is quite stable. As such, knee and lower leg injuries are often seen in conjunction with posterior hip dislocations. Due to the potential for significant complications, an attempt should be made to reduce posterior hip dislocations in the field.

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Posterior Hip Dislocation Signs & Symptoms

• Patient presents on back or side with hip slightly flexed and the leg on the affected side shorter and rotated inward.
• Moderate to severe pain; associated nerve injury and loss of nerve function is possible.
• Patient may have fractures to the knee, patella, femoral head, neck, shaft, or socket (acetabulum).

Posterior Hip Dislocation Treatment

• If the leg on the side of the dislocation has no significant fracture, one rescuer stabilizes patient’s hips while the second squats with arms crossed under patient’s knee and lifts, using their legs, until femoral head relocates.
• If reduction is successful, there is no nerve damage, and no indication of internal injuries, begin a Level 3 Evacuation.
• Begin a Level 2 Evacuation for patients with an unreduced posterior hip dislocation; death of the femoral head and permanent nerve damage may occur anytime within the following 24 hrs without reduction.
  

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Interested in anticipating and preventing potential problems in the outdoors? Want to be able to take  care of your family or friends should something unexpected happen? Take one of our wilderness medicine courses. Guides and expedition leaders should consider taking our Wilderness First Responder course.

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