HipTriage.com

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The content focuses on triaging orthopaedic injuries and conditions and was reviewed by site owner, Canadian Physiotherapist Terry Kane.  If you have any comments or suggestions to improve the content, please contact Terry at terry@terrykane.ca.


Triaging Hip Injuries

Introduction

Hip injuries are common in various settings, including sports, workplaces, and elderly populations. They range from minor strains to severe fractures that require urgent surgical intervention. Effective triaging of hip injuries is essential to ensure timely and appropriate treatment, reducing complications and improving patient outcomes. This article explores the principles of triaging hip injuries, including assessment strategies, classification of injuries, and management protocols.


Understanding Hip Anatomy and Function

The hip is a ball-and-socket joint formed by the femoral head and the acetabulum of the pelvis. It plays a crucial role in weight-bearing, mobility, and stability. Major structures include:

  • Bones: Femur, pelvis (ilium, ischium, pubis)
  • Ligaments: Iliofemoral, pubofemoral, ischiofemoral
  • Muscles: Hip flexors, extensors, abductors, adductors, and rotators
  • Nerves and blood vessels: Sciatic nerve, femoral nerve, obturator nerve, femoral artery

An understanding of hip anatomy is essential when evaluating injuries, as damage to any of these structures can lead to significant impairment.


Initial Assessment and Triage

Triaging hip injuries involves a systematic approach to determine the severity, prioritize care, and decide on further management. The primary assessment includes:

1. Primary Survey: Identifying Life-Threatening Conditions

For patients with high-impact trauma (e.g., motor vehicle accidents, falls from height), the ABCDE approach is critical:

  • Airway: Ensure patency and assess for head or cervical spine injuries.
  • Breathing: Look for associated thoracic injuries.
  • Circulation: Check for shock, which may indicate internal bleeding (e.g., pelvic fractures causing hemorrhage).
  • Disability: Assess neurological function (Glasgow Coma Scale, limb movement).
  • Exposure: Inspect for other injuries.

Patients who are unstable with signs of hemorrhage require urgent resuscitation and possible surgical intervention.

2. Secondary Survey: Focused Hip Assessment

Once stabilized, a detailed hip evaluation follows:

  • History: Mechanism of injury, pre-existing conditions (e.g., osteoporosis, arthritis), pain onset, and functional limitations.
  • Inspection: Look for deformities, swelling, bruising, and leg shortening or external rotation (suggestive of hip fractures).
  • Palpation: Assess for tenderness over the hip, pelvis, or groin.
  • Range of Motion (ROM): Painful or restricted movement may indicate fractures, dislocations, or soft tissue injuries.
  • Neurovascular Examination: Check distal pulses, sensation, and muscle strength to rule out nerve or vascular compromise.

Classification of Hip Injuries

Hip injuries are broadly categorized into fractures, dislocations, soft tissue injuries, and other conditions such as bursitis or avascular necrosis.

1. Hip Fractures

Hip fractures are common in elderly individuals due to falls and in young individuals due to high-energy trauma.

Types of Hip Fractures

  • Femoral Neck Fractures: Located within the capsule; risk of avascular necrosis due to disrupted blood supply.
  • Intertrochanteric Fractures: Occur between the greater and lesser trochanters; usually have a good blood supply.
  • Subtrochanteric Fractures: Extend below the lesser trochanter; require more complex fixation.

Triage and Management of Hip Fractures

  • Stable patients: Urgent orthopedic consultation and imaging (X-ray, CT scan if needed).
  • Unstable patients with suspected bleeding: Immediate resuscitation, stabilization, and surgical planning.

2. Hip Dislocations

Hip dislocations typically result from high-energy trauma and can be classified as:

  • Posterior dislocation (90% of cases): The femoral head is displaced backward; associated with sciatic nerve injury.
  • Anterior dislocation: The femoral head moves forward; may involve vascular injury.

Triage and Management of Hip Dislocations

  • Immediate reduction is required to prevent avascular necrosis.
  • Assess neurovascular status before and after reduction.
  • Post-reduction imaging and possible MRI to evaluate soft tissue injuries.

3. Soft Tissue Injuries

Soft tissue injuries include muscle strains, ligament sprains, and tendon injuries.

  • Hip Flexor Strain: Common in athletes; presents with anterior hip pain and difficulty flexing the hip.
  • Hamstring Tendon Injuries: Cause posterior hip pain; common in sprinters.
  • Iliotibial Band Syndrome: Lateral hip pain due to repetitive motion.
  • Labral Tears: Result from trauma or repetitive stress; cause clicking and deep hip pain.

Triage and Management of Soft Tissue Injuries

  • Mild cases: Conservative management with RICE (Rest, Ice, Compression, Elevation) and physical therapy.
  • Severe cases: MRI for further evaluation and possible surgical repair.

4. Other Hip Conditions

Some conditions mimic traumatic hip injuries but have different underlying causes.

  • Hip Bursitis: Inflammation of the bursae around the hip; managed with NSAIDs and physiotherapy.
  • Avascular Necrosis: Loss of blood supply to the femoral head; often seen in corticosteroid use or alcohol abuse.
  • Slipped Capital Femoral Epiphysis (SCFE): Common in adolescents; presents with a limp and hip pain.

Diagnostic Approach

Imaging Modalities

  • X-rays: First-line imaging for fractures and dislocations.
  • CT Scan: Useful for complex fractures and preoperative planning.
  • MRI: Best for soft tissue injuries, occult fractures, and avascular necrosis.
  • Ultrasound: Can assess soft tissue injuries and effusions in the hip joint.

Laboratory Tests

  • Blood tests: Assess for infection (e.g., septic arthritis), inflammatory markers, and metabolic bone diseases.

Definitive Management Strategies

1. Conservative Management

Indicated for minor injuries, including:

  • NSAIDs and analgesia: Pain control.
  • Physical therapy: Strengthening and mobility exercises.
  • Activity modification: Avoiding activities that exacerbate pain.

2. Surgical Management

  • Hip Fracture Fixation: Depending on fracture type, options include screws, plates, or total hip replacement.
  • Hip Dislocation Reduction: Performed under sedation or anesthesia.
  • Labral Repair or Debridement: For severe tears affecting function.

Rehabilitation and Recovery

Successful recovery involves:

  • Early Mobilization: Reduces complications such as deep vein thrombosis.
  • Weight-Bearing Guidance: Varies based on the type of injury and surgical intervention.
  • Strength and Conditioning Programs: Prevent recurrence and improve long-term function.

Conclusion

Triaging hip injuries requires a structured approach to differentiate between life-threatening and minor conditions.

A thorough assessment, appropriate imaging, and timely intervention are crucial for optimizing patient outcomes.

Healthcare professionals should remain vigilant for complications such as avascular necrosis, neurovascular compromise, and chronic disability.

By applying evidence-based triage and treatment strategies, healthcare providers can enhance the management of hip injuries and improve recovery rates for patients across all age groups.