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Although other lower
extremity joints take up much of the sports medicine
specialist’s time, injuries to the hip and pelvis are not
uncommon and can present a variety of diagnostic and treatment
problems.
From an anatomical
standpoint, the hip should be differentiated from the pelvis.
Many lay people and a few medical professionals use the
two interchangeably. They
are not.
The pelvis is a bony ring
formed by three bones that serves to protect internal organs and
as a scaffold for muscles, tendons, ligaments and other bones.
The hip is the joint between
the femur or thighbone and the pelvis.
It is a type of joint known as a ball and socket which
means that the head of the femur fits into a groove called the
acetabulum that is formed by the pelvic bones.
Fractures of the pelvis
require a great deal of trauma and are somewhat rare in sports
medicine. People
who ride horses or race motorcycles account for most of the
pelvic fractures seen in sports medicine.
Also, the tendons of the thigh muscles can occasionally
pull a small fragment of bone from the pelvis.
Femur fractures are not
extremely common in sports but cause sufficient morbidity to
warrant their inclusion. Several
times a year a football player, soccer player or motorcyclist
will break their femur, which is the largest bone in the body.
This is typically a fracture that must be corrected
surgically with a rod through the hollow portion of the bone.
The hip joint can
become dislocated in athletics. This is also somewhat
uncommon but it does occur several times a year in football or
equestrian activities.
This is one of the few true orthopaedic emergencies.
In adults, a great deal of force is required in order to
dislocate the hip. The
same is not true in children.
It is very important to get
someone with a suspected hip dislocation to a hospital as soon
as possible. The
quicker the hip is reduced (put back into place) the better.
Hips that remain dislocated for a long time are at
increased risk of developing a condition known as avascular
necrosis which can be difficult to treat.
An orthopaedist must also evaluate a hip dislocation for
associated femur or pelvic fractures.
Although fractures and
dislocations of the hip and pelvis are not as common as with
other joints, early recognition is critical for their proper
treatment. Never
delay having someone with a suspected fracture or dislocation of
the hip or pelvis evaluated.
Although not exclusive to
athletes, a condition known as a slipped capital femoral
epiphysis (SCFE) occurs in adolescent boys and girls.
SCFE occurs in growing youngsters who are nearing
skeletal maturity. There
are various theories about the etiology of SCFE, but what
essentially happens is that the head and neck of the femur
rotate in different directions. Adolescents with hip pain should be evaluated by an
orthopaedic specialist fairly quickly.
Early diagnosis and treatment can help reduce further
slippage and other complications.
The vast majority of SCFE cases are treated operatively
with internal fixation to prevent further slipping and
deformity.
A pelvis injury that is very
common in most collision sports is commonly known as a hip
pointer. This
injury is actually just a severe bruise that is quite painful
and difficult to treat and protect.
The front or anterior pelvis is quite sharp and, when
hit, can cause significant bony and soft tissue damage.
Treatment of a hip pointer
is protection with high density polyfoam or other protective
padding and the typical ice regimen common to other contusions. Hip pointers can be severe enough to sideline an athlete for
several days or weeks.
Bursitis of the hip is not
rare in athletics. Recall
that a bursa is a fluid filled sac that serves to increase the
mechanical advantage and decrease friction of a muscle or tendon
over a bony prominence. Runners
and other athletes who use their hip musculature excessively may
develop bursitis over the bones of the femur near the hip joint.
This is typically
correctable with correction of poor mechanics, oral
anti-inflammatory medications, ice and an occasional steroid
injection into the bursa. Rarely
does this type of bursitis require a surgical procedure,
especially in an athlete.
As you can see, there are a
variety of injuries that are possible in and around the hip and
pelvis. Acute and
severe leg or hip injuries should be evaluated by a doctor
immediately. These
are true orthopaedic emergencies.
Other more minor and/or common hip and pelvis injuries
should not escape evaluation by an orthopaedic surgeon.
Many of these conditions, such as SCFE, can appear benign
to the generalist and should be evaluated by an orthopaedic
surgeon.
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