Posterior hip dislocation

HPI: 22 yo otherwise healthy male presents s/p head on MVC vs tree. Patient is awake and alert, hemodynamically stable, complaining of right hip pain.
​
Physical Exam: No external signs of trauma. Right lower extremity is shortened compared to the left and internal rotated. No numbness, 2+ DP pulse.

​Classification:
​- Simple: pure dislocation
​- Complex: with associated fracture of acetabulum or proximal femur

​Mechanism:
​- Axial load on femur while hip flexed and adducted or through flexed knee (dashboard injury such as this patient)​

​Requires emergent reduction (within 6 hours!) due to risk of vascular compromise to hip and osteonecrosis

​However...

​Examine femoral neck closely on XR to rule out fracture prior to attempting closed reduction.
​
With ipsilateral femoral neck fracture, closed reduction is contraindicated!

 
​Patient must be adequately sedated for procedure.  Propofol helps with tissue relaxation!

​Post reduction CT must be performed to evaluate for:
​- femoral head fractures
​- loose bodies 
​- acetabular fractures 

​Commonly associated with ipsilateral knee injuries (up to 25%) 

​Dispo: For simple dislocation, protected weight bearing for 4-6 weeks
​

Resources:
1. Serna, Fernando MD, Corczyca, John MD. Hip Dislocations and Femoral Head Fractures. University of Rochester Medical Center. March 2004.
2. Orthobullets.com