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Exploration of his sciatic nerve
1%
58/4692
EMG
2%
72/4692
CT scan of his right hip
59%
2774/4692
Touch-down weight bearing of his right leg and observation of his sciatic nerve palsy
36%
1704/4692
Skeletal traction on the distal femur to relax tension on the sciatic nerve
50/4692
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Following successful reduction of a traumatic hip dislocation, a CT scan must be obtained to evaluate for any entrapped osteochondral fragments. Traumatic hip dislocations are typically the result of high-energy trauma and are frequently associated with posterior wall acetabular fractures. Initial management of a traumatic hip dislocation, with or without a fracture, is immediate closed reduction under conscious sedation. If closed reduction is unsuccessful, immediate open reduction in the operating room should be performed. Following successful reduction, a CT scan is necessary to rule-out intra-articular osteochondral fragments, even in the absence of fracture on radiographs. The incidence of sciatic nerve palsy following a traumatic hip dislocation is roughly 10%. Pascarella et. al. review 127 traumatic hip dislocations with and without associated fractures. 5 were anterior dislocations, 13 were central dislocations, and 109 were posterior dislocations. In 45 of the cases, an intra-articular fracture fragment was found after successful closed reduction. They stress the importance of post-reduction CT scans given the large incidence of intra-articular fragments. Bartlett et al. present a case study of a man who sustained cardiac arrest after attempted arthroscopic removal of a loose body in the hip following a traumatic hip fracture-dislocation. They believe that arthroscopic fluid extravasated through the fracture site under pump pressure and resulted in an intraabdominal compartment syndrome that presented as cardiopulmonary arrest. They do not support arthroscopic procedures of the hip following acute or healing acetabular fractures. Figure A shows an AP pelvic radiograph with a R hip dislocation. Figure B shows the post-reduction radiograph with a concentrically reduced hip joint and no evidence of fracture. Incorrect Answers: Answer 1: Acute exploration of the sciatic nerve is controversial, and shouldn't be entertained before a CT scan has been completed. Answer 2: EMG scan may be useful if the sciatic nerve fails to recover after a period of weeks to months. Answer 4: CT scan must be obtained, even in the absence of a fracture on radiographs. In the absence of entrapped fragments, and if a concentric reduction is obtained, the next step would be TDWB and observation of the sciatic palsy. Answer 5: Skeletal traction is not necessary if the hip is stable after concentric reduction and there are no associated fractures.
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