Emerg Med J 25:679-685 doi:10.1136/emj.2008.058727
  • Soft tissue injuries series

Soft tissue injuries: 4 Hip and thigh

  1. M Manning1,
  2. D Barron2,
  3. T Lewis1,
  4. J Sloan3
  1. 1
    St Helens and Knowsley NHS Trust, Whiston Hospital, Prescot, Merseyside, UK
  2. 2
    Leeds Universities Teaching Trust, Leeds, UK
  3. 3
    Emergency Department, Countess of Chester Hospital, Chester, UK
  1. Mr J Sloan, Emergency Department, Countess of Chester Hospital, Liverpool Road, Chester CH2 1UL, UK; jsloan{at}
  • Accepted 3 June 2008

In this fourth paper in the Soft Tissue Injury series we cover aspects of soft tissue injury relating to the hip. Our understanding of injuries to the hip and thigh have increased considerably in recent years, partly through more sophisticated investigation and partly through much greater investment in sports medicine.14 The hip joint is a true “ball and socket” articulation with inherent stability as a consequence of the containment of the femoral ball within the pelvic socket. The stability of the joint is further enhanced by a strong surrounding capsule and by a rim of fibrocartilaginous tissue called the acetabular labrum. The capsule thickens at several points to form capsular ligaments. The labrum effectively deepens the socket. The whole structure is enormously strong, generally resistant to injury but permitting a significant range of movement befitting the link between the trunk and the lower limbs.

The two halves of the pelvis are linked at the front by the symphysis pubis, and posteriorly by the two sacro-iliac joints (see fig 1). Neither the sacro-iliac nor the symphysis pubis normally permits movement, although the symphysis may widen and become painful during pregnancy. All the joints of the pelvis; sacro-iliac, symphysis pubis and hip can suffer dislocations with or without associated bony injury, although generally do so only with high energy injuries.

Figure 1 The bony pelvis viewed from anteriorly.

The condensation of the anterior part of the hip joint capsule is called the iliofemoral ligament (fig 2) and is considerably thicker than the ischiofemoral ligament, which covers the posterior aspect of the joint. Several layers of muscle overlay the capsule protecting the joint from direct injury and dynamically stabilise it during activity. Important nerves and vessels cross the joint and may be injured as a result of both penetrating and non-penetrating injury.

Figure 2 The hip joint, denuded of muscle, from anteriorly. The iliofemoral ligament is clearly shown.

The muscles crossing the joint are …

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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