Synopsis
Recognise anterior and posterior hip dislocation, document sciatic and femoral neurovascular status, reduce the joint urgently and safely, and detect associated fracture, non-concentric reduction and later avascular necrosis.
- Posterior hip dislocation usually presents with a shortened flexed, adducted, internally rotated limb; anterior dislocation is typically abducted and externally rotated.
- Run ABCDE after high-energy trauma and inspect the knee, femur, pelvis, abdomen and spine because dashboard force rarely injures the hip in isolation.
- Before and after every attempt, document dorsiflexion, great-toe extension, plantarflexion, sole and dorsum sensation, femoral function, pulses and capillary refill.
Key red flags
A cool pulseless limb, expanding groin or buttock swelling, open injury or progressive neurological loss requires immediate trauma, orthopaedic and vascular intervention.
Investigation priorities
Confirm direction and identify associated proximal femoral, acetabular and pelvic fracture.
Management branches
A painful fixed hip deformity follows trauma.
- Run ABCDE, support the limb, give analgesia and examine the pelvis, femur, knee, abdomen and spine for associated injury.
- Document sciatic and femoral motor and sensory function, distal pulses, refill and skin before sedation or manipulation.
Key medicines
First-line intravenous morphine for severe major-trauma painGive 2 mg intravenously, reassess after 5 minutes and repeat small 1–2 mg increments to effect under monitored local trauma guidance rather than giving an unobserved large bolus.