Health Library Hip Injuries, Age 11 and YoungerFrom Healthwise

A hip injury can be hard to deal with, both for the child who has the injury and to the parent or caregiver. A child who has a hip injury may feel pain in the hip, groin, thigh, or knee. A child in pain may limp or be unable or unwilling to stand, walk, or move the injured hip. A baby in pain may cry, be fussy, and have other signs of pain.

To better understand hip injuries, it may be helpful to know how the hip works. It is the largest ball-and-socket joint in the body. The thighbone (femur) fits tightly into a cup-shaped socket (acetabulum) in the pelvis. The hip joint is tighter and more stable than the shoulder joint but it does not move as freely. The hip joint is held together by muscles in the buttocks, groin, and spine; tendons; ligaments; and a joint capsule. Several fluid-filled sacs (bursae) cushion and lubricate the hip joint and let the tendons and muscles glide and move smoothly. The largest nerve in the body (sciatic nerve) passes through the pelvis into the leg.

Hip injuries

A sudden (acute) injury may occur from a fall on a hip, a direct blow to a hip or knee, or abnormal twisting or bending of the leg. Acute injuries include:

• Muscle strain in the hip, groin, or buttock.
• Bruising (contusion) of the hip muscles (hip pointer). Deep muscle bruising may occur with other injuries to the hip. Tenderness and muscle spasm may also be present.
• Dislocated hip, hip fracture, or pelvic fracture. Dislocations and fractures of the hips and pelvis are not often seen in children unless a severe injury (such as a car accident) has occurred.
• Avulsion fracture. This occurs when a muscle forcibly tears away from a bone and breaks a piece of bone.

Treatment for a hip injury depends on the location, type and severity of the injury as well as the child's age, general health, and activity level. Treatment may include first aid measures; application of a brace, cast, harness, or traction; physical therapy; medicines; or surgery.

Review the Emergencies and Check Your Symptoms sections to determine if and when your child needs to see a health professional.

• After an acute (sudden) injury:
  • Pieces of bone are visible in a wound, or a bone is sticking through the skin.
  • Severe pain occurs.
  • A lot of swelling began within 30 minutes of the injury.
  • A leg looks twisted or out of its normal position.
  • A new large bump is present at the site of a suspected fracture or dislocation.
  • Numbness or tingling is present in the buttocks, genital area, or one or both legs.
  • A hip or leg has turned pale, white, blue, or cold.
  • A child is not able to bend, straighten, or move your leg normally.
  • A child is not able to stand or walk or bear weight.

Note: A child with a severe hip injury needs to be transported on a special board to prevent movement (immobilization board). A special type of splint (traction splint) may also be needed. Do not move the child unless there is an immediate threat to his or her life, such as a fire. If the child is in immediate danger, keep his or her head, neck, back, and pelvis supported and in a straight line while you move the child to safety.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your child's hip symptoms.

If your child has any of the following symptoms, evaluate those symptoms first.

• Hip problem without an injury: Go to the topic Hip Problems, Age 11 and Younger.
• Bleeding: Go to the topic Cuts or Puncture Wounds.

	Yes	Does your child have hip pain or tenderness after an injury?
When to See a Doctor See significance of pain or tenderness if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's hip symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your child have severe hip pain? Yes Is your child unable or unwilling to walk? Yes Does your child cry with any hip movement? Yes Is your child's hip painful, red, hot, and swollen? Yes Does your child have hip pain and a fever? Call your child's health professional today if you answer "Yes" to the following question. Yes Has your child had a hip injury and is still crying after 30 minutes of comforting? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Does your child still have moderate hip pain after 24 hours of home treatment? Yes Does your child still limp after 48 hours (or the time frame given by a doctor) of recommended home or medical treatment? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Has your child complained of mild hip pain off and on for 1 week or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Is your child limping or unable or unwilling to put weight on one leg?
When to See a Doctor See significance of limping or the inability or unwillingness to put weight on one leg if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's hip symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Is your child unable or unwilling to walk? Yes Is your child unable or unwilling to put weight on one leg? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Is your child walking with a new limp? Yes Does your child's leg look different than the other leg? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Has your child's limp become worse since being seen by a doctor 2 days ago? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Has your child been limping off and on for more than a week? Yes Does one of your child's legs look shorter than the other one? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Is your child unable to normally bend, straighten, or move a leg?
When to See a Doctor See significance of an inability to normally bend, straighten, or move a leg if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's hip symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Is your child unable to bend, straighten, or move a leg normally? Yes Does your child have severe hip pain and does not want to move the affected leg? Yes Has your child had hip surgery and now has sudden moderate to severe hip pain and cannot move the hip or leg? Yes Is your child not able to move a leg normally after having a leg brace, cast, or splint put on (not because the splint is in the way)? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes After 48 hours of home treatment, is your child's hip still stiff and he or she cannot move the hip normally? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have signs of inflammation or infection in the hip?
When to See a Doctor See significance of signs of inflammation or infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's hip symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your child have increased swelling, redness, or warmth around the hip? Yes Does your child have increased pain with movement of the hip? Yes Does your child have red streaks extending from the hip? Yes Is your child's hip tender to the touch? Yes Does your child have any drainage of pus from the hip? Yes Does your child have swollen lymph nodes near the hip? Yes Do you know or think your child has a fever? Yes Does your child have any other medical conditions, such as diabetes, leukemia, or hemophilia? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Does your child have mild pain and swelling with redness less than 2 in. (5 cm) around the hip? Yes Does your child have swollen lymph nodes in the groin? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your child's hip problem may have been caused by abuse?
When to See a Doctor See significance of abuse if you need information to help you answer the question below. Review health risks that may increase the seriousness of your child's hip symptoms. Call your child's health professional immediately if you answer "Yes" to the following question. Yes Do you think your child's hip problem, limp, or inability to walk may have been caused by abuse? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have pale, white, blue, or cold skin after a brace, cast, or splint was put on?
When to See a Doctor See significance of pale, white, blue, or cold skin if you need information to help you answer the question below. Review health risks that may increase the seriousness of your child's hip symptoms. Call your child's health professional immediately if you answer "Yes" to the following question. Yes Does your child have pale, white, blue, or cold skin after a brace, cast, or splint was put on? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Does your child have any of the following symptoms?

• Groin pain: Go to the topic Groin Problems and Injuries.
• Tailbone or low back injury: Go to the topic Back Problems and Injuries.
• Unexplained leg pain or swelling: Go to the topic Leg Problems, Noninjury.
• A leg injury: Go to the topic Leg Injuries.
• Limping after a toe, foot, or ankle injury: Go to the topic Toe, Foot, and Ankle Injuries.
• Limping after a knee injury: Go to the topic Knee Problems and Injuries.
• A burn, scrape, bite, or bruise: Go to the topic:
  • Burns.
  • Scrapes.
  • Animal and Human Bites.
  • Puncture Wounds.
  • Bruises and Blood Spots Under the Skin.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home treatment may help relieve your child's hip pain, swelling, and stiffness. If your child will cooperate, use the following tips. If your child becomes upset or will not cooperate, do not force your child.

• Rest. Have your child rest and protect the sore hip. Have your child stop, change, or take a break from any activity that may be causing pain or soreness.
• Ice will help your child's pain and swelling. Put ice or cold packs on the sore area immediately. Put ice on for 20 minutes out of every hour and do this 4 or more times in the first 1 to 2 days. If your child is cooperative, use the ice often. If your child is not cooperative, use the ice as much as you can without struggling with your child. Wrap the ice in a wet towel. Do not put the ice right on the skin. Take the ice off if your child falls asleep.
• Place your child on the uninjured side for sleep.
• Gently massage or rub your child's hip to relieve pain and encourage blood flow.
• For the first 1 to 2 days after an injury, do not let your child do things that may increase swelling, such as taking hot showers, using hot tubs, or hot packs.
• After 2 to 3 days, if the swelling is gone, heat can be put on the hip. Your child can carefully begin normal activities. Moist heat with a hot water bottle, warm towel, or a heating pad set on low may feel good to your child.

Cast care tips

If your child has a cast, see cast care tips.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your child's symptoms if any of the following occur during home treatment.

• Signs of infection develop.
• Numbness, tingling, or weakness develops.
• Pale, white, blue, or cold skin develops.
• Symptoms do not get better with home treatment.
• Symptoms become more severe or more frequent.

The following tips may prevent the chance of hip injuries.

• Always be gentle with your child. Do not grab your child by his or her legs.
• Be aware of your child's chance of falling, and take steps to prevent falls.
• Never leave a baby unattended in high places, such as on a tabletop, in a crib with the sides down, or even on a bed or sofa.
• Do not leave a baby unattended in any infant seat or "sitting" toy, such as a swing, walker, saucer, or jumper. Use all the safety straps provided.

Establish good safety habits early so that your child will continue them when he or she is older.

• Place children in an approved child car seat when riding in a motor vehicle. Follow the manufacturer's directions for installing and securing the seat.
• Have older children wear seat belts every time they are in a motor vehicle. Set a good example by always using your seat belt when traveling in a motor vehicle.
• Have your child wear protective gear when playing contact sports such as football or hockey.

Injuries may occasionally be a sign of abuse. You may be able to prevent further abuse by reporting it and seeking help.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your health professional diagnose and treat your child's condition by being prepared to answer the following questions:

• What are your child's main symptoms? How long has your child had symptoms?
• How and when did an injury occur?
• Has your child had any injuries in the past to the same area? Does your child have any continuing problems because of the previous injury?
• Does your child limp or complain about pain when he or she walks? Where is the pain felt? How far can your child walk without discomfort? Does the pain get better or worse as he or she continues to walk?
• What activities make your child's symptoms better or worse?
• What activities is your child involved with? Has your child recently started a new activity?
• What home treatment measures have you tried? Did they help?
• What prescription or nonprescription medicines has the child taken? Did they help?
• Does your child have any health risks that may increase the seriousness of his or her hip symptoms?

• Back Problems and Injuries
• Groin Problems and Injuries
• Knee Problems and Injuries
• Leg Injuries
• Leg Problems, Noninjury
• Toe, Foot, and Ankle Injuries

Author:	Jan Nissl, RN, BS	Last Updated: October 27, 2006
Medical Review:	Michael J. Sexton, MD - Pediatrics Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
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