Injuries around the hip constitute one of the most difficult injuries to treat and predict the outcome. But the best way to treat your pain is by Physical Therapy without any Burn and Injury. In dashboard injuries, the impact is driven to the knee of the patient which passes on the energy of hip joint causing posterior dislocation of hip.
Examination
Inspection
Attitude: The examination of attitude in a hip joint injury is very useful. In posterior dislocation of hip, the hip will be in flexion, adduction and internal rotation. In intracapsular fracture neck of femur, the lower limb lies in external rotation and minimal shortening. In trochanteric fractures, the lower limb lies in complete external rotation and the limb appears shortened. In anterior dislocation of hip, there will be flexion, abduction and external rotation deformity.
Swelling: In dislocation of hip, the femoral head may be felt either in the gluteal region or in the perineal region or iliac region. In trochanteric fracture, there will be diffuse swelling around the hip and thigh.
Palpation
The bony landmarks to be palpated are:
1.Greater trochanter: The position of greater trochanter helps us in the diagnosis of fractures around the hip. The greater trochanter, anterior superior iliac spine (ASIS) and ischial tuberosity have a constant relationship to each other which will be altered in affections of hip joint and proximal femur. Bryant’s triangle is formed by a line connecting ASIS and greater trochanter, line dropped from the ASIS perpendicular to the floor and the line connecting the greater trochanter and the perpendicular line. The base of the Bryant’s triangle is measured and compared with opposite side. In fractures of the neck and dislocations of hip, the base will decrease to the proximal migration of the trochanter. In posterior dislocations of hip, the greater trochanter will be more anteriorly felt near the ASIS. In anterior dislocations, it will be felt more posteriorly. It should be palpated for tenderness, thickening or irregularity. In subtrochanteric fractures, Bryant’s triangle will not be altered but there will be loss of transmitted movements between the proximal and distal femur.
2.Head of femur: Normally, the femoral arterial pulsation is felt against the head of femur. In dislocations, this resistance is lost thereby altering the intensity of pulsation. The femoral head may be felt posteriorly or anteriorly depending on the type of dislocation. A smooth round bony hard mass which moves with rotational movements of the shaft of femur is nothing but the head of femur. The medial surface of the medial femoral condyle is in the same direction as that of the head of femur. This gives a rough guidance to locate the head in an intact femur.
Neurological examination
In posterior dislocations of hip, the nerve to be commonly affected is the sciatic nerve. The common peroneal part of the sciatic nerve is most often involved than the tibial part manifesting as foot drop.
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