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.
- Simple: pure dislocation
- Complex: with associated fracture of acetabulum or proximal femur
- 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
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
1. Serna, Fernando MD, Corczyca, John MD. Hip Dislocations and Femoral Head Fractures. University of Rochester Medical Center. March 2004.
CMC ER Residents
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