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Hip Dislocations

11/25/2014

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HPI: 
Patient 1: Restrained passenger of a head on MVC. 
Patient 2: Elderly patient with fall from standing.
 
Physical Exam: 
Patient 1: Hip flexed and internally rotated. Unable to straighten the leg. Unable to walk.
Patient 2: Hip flexed and externally rotated. Unable to straighten the leg. Unable to walk.
 
Imaging: 
Patient 1: Posterior hip dislocation of native hip. 
Patient 2: Superolateral hip dislocation of prosthetic hip. 

Posterior Hip Dislocation

Picture

Prosthetic Hip Dislocation

Picture
Treatment: 
  • Posterior hip dislocations: Stand on the bed over the patient, flex/internally rotate/adduct the hip and pull traction, then attempt to straighten out the leg while continuing traction.
 
  • Anterior hip dislocations: With leg extended, externally rotate and extend off the edge of the bed. Then pull traction and slowly internally rotate the leg while still in traction.
 
  • Native hip - Highest risk for femoral neck fractures w/ relocation. Emergently intubate, paralyze, and try to reduce as soon as possible (within 6 hours) before the muscles tighten down. Contraindication to reduction is a femoral neck or acetabular fracture whether displaced or non-displaced. Up to 20% chance of associated sciatic nerve injuries. Perform post-reduction CT bony pelvis for all traumatic hip dislocations of native hips.
 
  • Operative repair of native hip dislocation if... delayed presentation, femoral neck fracture, irreducible dislocation, or incarcerated bone fragment. Associated fractures of the acetabulum also require ORIF. 
 
  • Prosthetic hip - Patients go to the PACU w/ ortho for a propofol sedation and hip relocation. Discharged from the PACU if hip stable after relocation. No post-reduction CT required. 
 
  • 4-6 weeks of touch down weight bearing after native hip relocation.

****Don't forgot you can find the ED Policy for Deep Sedation on the Top 20 Page.  Anesthesia must be present for intubation.  Click here to read more.  
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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • UNC/Wake Forest Students
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction