- See:
Frx Dislocations of the Hip:
- Discussion:
- because of associated high energy trauma: look for other injuries
- vast majority of patients sustained a hip dislocation will have associated injuries;
- assoc ligamentous injuries to ipsilateral knee;
- associated
posterior wall fractures, femoral head, and shaft fractures;
- posterior dislocations w/
femoral shaft frx may go unrecognized because classic
clinical position of flexed, internally rotated, & adducted limb is not present;
- in general, patients w/ posterior hip dislocations will have internal rotation of the hip, where as patients w/
anterior dislocations will have external rotation of the hip;
- if this is not the case, be suspicious for femoral neck or shaft frx, or an ipsilateral knee dislocation;
- associated injuries: (proximal to distal);
- blunt thoracic and abdominal trauma;
-
pelvic frx;
-
acetabular frx (including contra-lateral side);
- femoral head frx:
- femoral head frx or neck frx may occur in upto 36%;
-
femoral neck frx:
-
femoral shaft frx;
-
sciatic nerve palsies;
- seen in 10-30% of cases;
- iatrogenic injury may be the result of laceration, penetration by drill bits, excessive traction
by retractors, or prolonged extension of the ipsilateral knee;
- it appears that injuries of peroneal division of sciatic nerve have a worse prognosis
than injuries of the tibial division;
-
knee dislocation or ligament injuries;
-
patellar frx;
- foot and ankle frx;
-
Case Example:
- 25 yo male, wt 350 lbs, who was ejected from moving vehicle;
- pts injuries included left brachial plexus and axillary artery disruption,
left scapular frx, right knee and right hip dislocation;
- the right hip dislocation was initially missed on the portable x-ray,
probably as a consequence of a poor quality x-ray along w/
the patient's rotound body habitus;
- note the asymmetry of the femoral heads and the absence of a
joint space on the right side;
- the radiograph on the far right was taken during the arteriogram;
