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 same. The pelvis is a bony ring formed by three bones that serves to protect internal organs and as a scaffold for muscles, tendons, and ligaments and other bones. The hip is the joint between the femur (thigh bone) 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 depression in the pelvis bones called the acetabulum.
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 pelvis fractures seen in sports medicine. Also, the tendons of the thigh muscles can occasionally pull a small fragment of bone off the pelvis.
Femur fractures are not extremely common in sports but cause sufficient morbidity to warrant their inclusions. Several times a year a football player, soccer player or motorcyclist will break his femur, the largest bone in the body. This is typically a fracture that must be corrected surgically by placing a rod through the hollow portion of the bone. The internal rod then allows the thighbone to heal with correct length without angulation.
The hip joint sometimes becomes dislocated in athletes. This occurs several times a year in football and equestrian activities. This is a true orthopaedic emergency. In adults, a great deal of force is required in order to dislocate the hip. This is not the case 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 in 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.
Avascular necrosis (death) of the femoral head will often lead to arthritis. An orthopaedist must also evaluate a hip dislocation for associated femur or pelvis 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 from being 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 or groin 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 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 cans see, there are a variety of injuries that are possible in and around the hip and pelvis. Acute and sever leg or hip injuries should be evaluated by a doctor immediately. There 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.
