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A 41-year-old female sustains the injury shown in Figure A as a result of a high-speed motor vehicle collision. After a successful attempt at closed reduction in the emergency room using conscious sedation, repeat radiographs show a reduced hip joint. What is the next most appropriate step in treatment?
Femoral skeletal traction
CT scan of hip and pelvis
Dynamic fluoroscopic examination under general anesthesia
Hip spica dressing
Touch down weight bearing mobilization
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The radiograph shown in Figure A reveals a left hip dislocation, with some obscuring of detail secondary to the trauma backboard. CT scans should be obtained following a hip dislocation to evaluate for fractures or impacted areas of the femoral head or acetabulum, as well as noncongruent reductions and free intraarticular joint fragments.
The referenced study by Brumback et al comments on the importance of post-reduction CT scans and found that 23% of their posterior wall fractures had associated marginal impaction, with 94% of these discovered via preoperative CT scan.
Brumback RJ, Holt ES, McBride MS, Poka A, Bathon GH, Burgess AR.
J Orthop Trauma. 1990;4(1):42-8. PMID: 2313429 (Link to Abstract)
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A 30-year-old driver is involved in a motor vehicle collision and sustains the injury shown in Figure A. What is the most likely concomitant injury?
Right knee meniscus tear
Left knee ACL tear
Right ankle fracture-dislocation
Lumbar burst fracture
Traumatic hip dislocation results from the dissipation of a large amount of energy about the hip joint. Clinically, these forces often are first transmitted through the knee en route to the hip. It is therefore logical to look for coexistent ipsilateral knee injury in patients with a traumatic hip dislocation.
Schmidt, et al, prospectively evaluated the ipsilateral knee of all patients who had a traumatic hip dislocation and found that 93% had abnormalities on MRI of the knee, with effusion (37%), bone bruise (33%), and meniscal tear (30%) being the most common findings. They suggest liberal use of MRI to the ipsilateral knee if injury is suspected.
Schmidt GL, Sciulli R, Altman GT
J Bone Joint Surg Am. 2005 Jun;87(6):1200-4. PMID: 15930527 (Link to Abstract)
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HPI - Pain in left hip joint for last 20 years which gradually increased to present stage. At the age of 10 years patient sustained a fall followed by symptoms, and was treated conservatively. Pain increases on walking for long distances (250 meters) and decreases with rest. No other relevant infection history,
How would you treat this patient in your institution?
HPI - fell from motor cycle 9 months ago, is walking with a limp.Has had no treatment.
treatment with limited resourses
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