After a car accident, most attention goes to the neck, back, and whiplash—but many patients actually have occult hip injuries that are missed at first. Standard ER imaging often looks “normal,” and symptoms get blamed on the low back or sacroiliac (SI) joint instead of the hip joint and labrum.
At SIGMA Orthopedics & Sports Medicine, we’ve developed a Head-and-Hip Injury Protocol to systematically evaluate the hip after motor vehicle accidents, especially when pain, instability, or clicking just don’t match a simple lumbar strain.
At SIGMA, our goal is simple: find the exact source of your pain, fix it with precision, and guide you through a data-driven return to full activity.
If your neck and back treatments haven’t fixed your symptoms, it may be time to look carefully at the hip joint, labrum, and surrounding tendons.
1. Scene Assessment and Triage:
– Ensure scene safety
– Perform primary survey (ABCDE approach)
– Immobilize the patient if spinal injury is suspected
2. Pre-hospital Care:
– Provide pain management
– Apply pelvic binder if pelvic fracture is suspected
– Initiate fluid resuscitation if signs of shock are present
3. Emergency Department Evaluation:
– Conduct secondary survey
– Obtain detailed history of the accident mechanism
– Perform focused hip and pelvis examination
– Assess neurovascular status of lower extremities
1. Imaging Studies:
– Plain radiographs (AP pelvis, lateral hip)
– CT scan for detailed fracture assessment
– MRI for soft tissue injuries and occult fractures
2. Laboratory Tests:
– Complete blood count
– Coagulation profile – Serum electrolytes and renal function tests
3. Additional Investigations:
– Angiography if vascular injury is suspected
– Nerve conduction studies for neurological deficits
1. Fractures:
– Femoral head fractures
– Femoral neck fractures
– Intertrochanteric fractures
– Subtrochanteric fractures
2. Dislocations:
– Posterior hip dislocations
– Anterior hip dislocations
3. Soft Tissue Injuries:
– Labral tears
– Muscle strains (e.g., iliopsoas, rectus femoris)
– Ligamentous injuries
4. Combined Injuries:
– Fracture-dislocations
– Associated pelvic ring injuries
1. Non-operative Management: Indications:
– Stable, non-displaced fractures
– Certain soft tissue injuries
Techniques:
– Protected weight-bearing
– Pain management
– Physical therapy
– Assistive devices (crutches, walker)
2. Operative Management: Indications:
– Displaced fractures
– Unstable fractures
– Hip dislocations with associated fractures
Surgical Techniques:
– Open reduction and internal fixation (ORIF)
– Closed reduction and percutaneous fixation
– Arthroplasty (hemiarthroplasty or total hip replacement)
– Arthroscopic procedures for labral repairs
3. Emergency Procedures:
– Closed reduction of hip dislocations
– External fixation for unstable pelvic injuries
1. Pharmacological Interventions:
– NSAIDs for mild to moderate pain
– Opioids for severe pain
– Muscle relaxants for associated muscle spasms
2. Non-pharmacological Approaches:
– Ice therapy
– Positioning and immobilization
– Transcutaneous electrical nerve stimulation (TENS)
3. Interventional Techniques:
– Intra-articular injections
– Nerve blocks (e.g., fascia iliaca block)
1. Acute Phase (0-2 weeks):
– Pain and swelling management
– Gentle range of motion exercises
– Isometric muscle strengthening
– Gait training with assistive devices
2. Subacute Phase (2-6 weeks): – Progressive weight-bearing as tolerated
– Increased range of motion exercises
– Strengthening exercises for hip and core muscles
– Balance and proprioception training
3. Late Phase (6-12 weeks):
– Full weight-bearing activities
– Advanced strengthening exercises
– Functional training
– Sport-specific or occupation
-specific exercises
4. Return to Activities:
– Gradual return to daily activities
– Work hardening programs
– Sports-specific training for athletes
1. Avascular Necrosis:
– Regular radiographic follow-up
– Core decompression in early stages
– Arthroplasty for advanced cases
2. Post-traumatic Arthritis:
– Conservative management with physical therapy and pain control
– Arthroplasty for severe cases
3. Heterotopic Ossification:
– Prophylaxis with NSAIDs or radiation therapy
– Surgical excision if functionally limiting
4. Venous Thromboembolism: – Early mobilization
– Mechanical prophylaxis (compression stockings)
– Pharmacological prophylaxis (low molecular weight heparin)
5. Neurovascular Injuries:
– Close monitoring of neurovascular status
– Surgical exploration and repair if indicated
1. Elderly Patients:
– Higher risk of complications
– Early mobilization to prevent deconditioning
– Osteoporosis management
– Fall prevention strategies
2. Polytrauma Patients:
– Prioritization of injuries
– Damage control orthopedics in unstable patients
– Multidisciplinary approach to care
3. Athletes:
– Accelerated rehabilitation protocols
– Sport-specific functional training
– Psychological support for return to sport
4. Pregnant Patients:
– Modified imaging techniques to minimize radiation exposure
– Careful medication selection
– Positioning considerations during treatment
1. Regular Clinical Assessments:
– Pain evaluation
– Functional outcome measures
– Quality of life assessments
2. Imaging Studies:
– Serial radiographs to monitor healing and detect complications
– Advanced imaging (CT, MRI) as indicated
3. Ongoing Rehabilitation:
– Home exercise programs
– Periodic physical therapy reassessments
– Lifestyle modifications for joint protection
4. Psychosocial Support:
– Screening for post-traumatic stress disorder
– Referral to mental health services if needed
– Support groups for MVA survivors
1. Minimally Invasive Techniques:
– Percutaneous fixation methods
– Computer-assisted surgery
2. Biological Augmentation:
– Platelet-rich plasma injections
– Stem cell therapy for cartilage regeneration
3. Advanced Imaging Modalities:
– 3D printing for pre-operative planning
– Functional MRI for assessing muscle activation patterns
4. Wearable Technology:
– Smart implants for real-time monitoring of healing
– Exoskeletons for gait assistance during rehabilitation
5. Virtual Reality in Rehabilitation:
– Immersive environments for balance training
– Gamification of exercise programs for improved adherence