Story by: Henry Winkelhake on February 6, 2020
Hip injuries like the one that ended University of Alabama quarterback Tua Tagovailoa’s season are more common in auto wrecks, but can occur in high-speed contact sports collisions.
The hip dislocation experienced by Tua happened in the Nov. 14 game against Mississippi State.
“While this type of injury can occur in football, we fortunately don’t see it often,” said Chad Smith, M.D., head team physician for University of Louisville football and orthopedic surgeon with Norton Sports Health and Norton Orthopedic Institute. “If the injury does occur, speeding the athlete to immediate treatment to prevent further damage is essential.”
The hip joint is the intersection between the ball of the femoral head at the top of the thigh bone and the socket in the pelvis. In a dislocation, the femoral head dislodges and either pushes backwards or, less commonly, moves forward to the front.
Hip dislocations not only are extremely painful, they are medical emergencies that require immediate treatment.
Patients typically are unable to move the leg. The dislocation itself can damage surrounding nerves, ligaments, muscles and tissues. In some instances, blood flow to the femoral head may be disrupted and can result in bone death.
Diagnosis: Often the hip will appear visibly deformed with the leg shortened and hip flexed. Medical staff will perform imaging tests such as an X-ray, magnetic resonance imaging (MRI), or computed tomography (CT) scan to diagnose the injury. These tests also help detect any damage, such as a fracture, caused by the dislocation.
Treatment: Sometimes a physician can manually put the femoral head back into the socket while the patient is sedated. The procedure — called a reduction — was performed on Tua at the stadium shortly after his injury.
Recovery: Recovering patients are advised to refrain from hip motion and bearing weight on the leg for several weeks to prevent dislocation from recurring. Sometimes up to two to three months is required for healing, as the joint is still fragile. Physical therapy can help with a faster and more complete recovery.
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Dislocation of a hip can be accompanied by a fracture to the back of the hip socket. The femoral head is forced back, causing a break in the back wall of the pelvis — one of the most common types of fractures in a high-energy hip injury.
When the socket (or acetabulum) itself has been fractured, plates and screws may be used to repair the break and provide stability.
Hip fractures are extremely common as a result of falls in elderly people due to osteoporosis, a weakening of the bones with age. Bones that have been severely weakened by this process can fracture from merely rotating the leg. Like dislocations, fractures also can occur from trauma sustained in automobile accidents and contact sports. These types of high-energy hip fractures are more common in younger patients, while low-energy fractures from ground-level falls are more common in older patients.
Patients who experience hip fractures typically feel sharp pain in the outer, upper thigh, or sometimes in the groin. As with hip dislocations, patients typically are unable to put weight on the injured leg. It is also possible that the affected leg may appear shorter in length. These injuries also threaten surrounding muscles, ligaments, nerves and tissues.
Diagnosis: The process for diagnosis is similar to that of a dislocation. Abnormal positioning of the hip may be visible. Imaging tests will be performed to diagnose the injury including X-rays, MRIs, or CT scans.
Treatment: Hip fractures will require surgery most of the time. Metal rods and occasionally screws are used to hold the bone in place as it heals. Quite often, part or all of the hip may need to be replaced in a procedure called an arthroplasty. The need for hip replacements is common among elderly patients who fracture the femoral neck just below the ball at the hip joint. Patients with minor fractures or who are unable to receive anesthesia may be treated without surgery.
Recovery: Most patients are encouraged to get up and on their feet on the first day after surgery. Quickly beginning physical therapy can speed recovery by working on strength and range of motion. Regaining full, unassisted mobility may take many months. The use of a walker, followed by a cane, is typically required until full strength is regained.
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