Chapter 24. Acute Injuries of the Hip, Pelvis, and Thigh

Anatomy, relevant to the present discussion, is depicted and described in Figures 24-1, 24-2, 24-3, and 24-4.

Definitions and Epidemiology

One study reported that 2.5% of all sports injuries were hip injuries, and in high school athletes, hip injuries were 5% to 9% of all athletic injuries. Apophyseal avulsions and musculotendinous strains are the most common acute injuries of hip, pelvis, and groin seen in youth sports.1–9

Mechanisms

Mechanisms are discussed below under specific injuries. Common mechanisms of injury include waterskiing and hurdling for hamstrings tears or avulsions, direct trauma to the anterior pelvis for iliac crest avulsions, and skiing and snowboarding falls with associated hip dislocations, and acetabular fractures.

Clinical Presentation

The athlete may present with a history of direct or indirect injury to the hip and pelvis from a fall, collision, or injury from “noncontact” sports. The young athlete may also present with chronic hip pain after overuse, such as distance running, which may be associated with a stress fracture of the femoral neck, or other associated injuries.4,5

The main symptom in many cases is the sudden onset of groin or hip pain, or pain along the iliac crest with avulsion injuries, as well as thigh or buttock pain with hamstring tears or apophyseal injuries. The patient may be reluctant to bear weight on the limb with a proximal femur or acetabular fracture, or an injury to the femoral head. The young athlete may present complaining of a click or catch with snapping in their hip resulting from an injury to the labrum or to the iliopsoas tendon or bursa6,7

Physical Examination

Examination should include lower back and both lower extremities.

Inspection

Look for swelling about the hip and surrounding structures, and any bruising or evidence of direct trauma to the soft tissues, such as ecchymosis about the proximal posterior thigh with a hamstring strain. ...