Xray Vision

MVC: Answer

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here’s another image of the portable xray.

hip1

Case: 30 year old female restrained driver BIBEMS after her vehicle collided with a pole at a high speed.

The official read of the portable pelvis film: “dislocation of both femoral heads and bilateral acetabular fractures. Fractures of the right superior and inferior pubic rami noted. There is a fracture through the left pubic symphysis. Fractures of the left superior and inferior pubic rami. Fracture of the left iliac wing is present. “

 

Hip Dislocations

Types:

  • Anterior
  • Posterior (90% of hip dislocations)
  • Central

Posterior hip dislocation (dashboard injury)

  • Occurs with axial load on femur (with hip flexed an adducted
  • Axial load through flexed knee
  • Presentation: hip and leg in slight flexion, adduction, and internal rotation
  • Associated with: osteonecrosis, posterior wall acetabular fracture, femoral head fractures, sciatic nerve injuries, ipsilateral knee injuries (up to 25%)
  • Imaging: xray can typical see posterior dislocations on AP pelvis. CT helps to determine direction of dislocation, loose bodies, and associated fractures. Post reduction CT must be performed for all traumatic hip dislocations to look for femoral head fractures, loose bodies, acetabular fractures

Treatment:

  • Isolated posterior dislocation (without fracture): closed reduction under procedural sedation as soon as possible (within 6 hours). In- line traction: gentle flexion to 90 degrees and then gentle internal to external rotation. Stimson maneuver: downward traction is placed on the femur at the knee while using the other hand for external and internal rotation. An assistant then places direct pressure on the femoral head.
  • Hip dislocations with fracture: get orthopedics and trauma involved early. Needs operative repair

 

Note: If pelvis is involved consider retroperitoneal bleed and resuscitation with crystalloid, blood, blood products, and TXA.

 

by joyce wang

 

Tintinalli’s Emergency Medicine:  A Comprehensive Study Guide

Wheeless’ Textbook of Orthopaedics online

http://www.orthobullets.com/trauma/1035/hip-dislocation

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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