Anterior Hip Dislocation

1. Pelvis Case # 7

2. 28 YOM presents s/p fall from 2 story building. He fell off of a balcony while trying to impress his friends. He is complaining of hip pain. History and Physical T 99.7 P 109 BP 117/62 O2 100% Gen: moderate distress CV: RRR, no m/r/g Ext: right leg externally rotated, shortened

3. Image

4. Diagnosis: Anterior Hip Dislocation

5. First rule out Femoral Neck frx before reduction Anterior Reduction (<8 hours): Rochester method or traction/ countertraction Consider post-reduction CT to rule out posterior wall frx (determines stability) Ipsilateral knee involvement in ~25% of injuries  careful exam Reduce  immobilize in slight abduction  admit for pain control and immobilization (may require 2 wks ) ED Management

6. 10-15% of hip dislocations Mechanism of Action: Blow from behind with hips abducted/knee strikes dashboard with hip abducted Fall from height second most common mechanism Occurs with femoral neck levers on rim of acetabulum the femoral head out of acetabulum  tear in ant. Hip capsule Asses for fx of acetabular rim, femoral head/neck Avascular Necrosis in up to ~4% Compression of femoral NV bundle Femoral Head fx up to 75%  possible surgical reduction Pearls, anterior

7. http:// www.feinberg.northwestern.edu/emergencymed/residency/ortho-teaching/pelvis-hip/case3/case3background.html http://imaging.consult.com/image/topic/dx/Musculoskeletal?title=Hip%20Dislocation,% 20Anterior&image=fig1&locator=gr1&pii=S1933-0332(06)70930-2 http://emedicine.medscape.com/article/823471-treatment#a1126 Simon, Robert, and Scott Sherman. Emergency Orthopedics. New York: McGraw Hill, 2011. 6 th Ed. References