Crossword Puzzles:
Antidotes Used In Toxicology

Orthopedics

September 2005 Radiology Quiz

27 year old male present as the unrestrained passenger in a MVC.  The car of the patient was traveling approximately 35 mph when it struck a stationary trash collection truck. The patient denies chest pain, SOB, LOC, but is complaining of right hip pain and keeps his thigh somewhat flexed throughout the FAST exam. A trauma series is performed.

1. Describe what you see: A/P radiograph of the pelvis demonstrating the head of the femur   displaced posterior to the acetabulum. There is no evidence of fracture of the femur or pelvis.

                     Diagnosis: Posterior hip dislocation.

2. What is the most common cause of this injury?

• Motor vehicle collision with the thigh flexed, adducted, and internally rotated with a force transmitted through the long axis of the femur.

3. What are some of the complications from this injury?

• Avascular necrosis (AVN), traumatic arthritis, fractures,  nerve injury (femoral or sciatic), joint instability.

4. What is the most appropriate management of this injury?

• Analgesia.
• Closed reduction with conscious sedation (refer to Stimson and Allis techniques).  Reduction should be performed as soon as possible to decrease the incidence of AVN, traumatic arthritis, and joint instability.
• Post reduction x-rays.

   If a fracture is present with the dislocation reduction should not be done by the ED physician secondary to risks of complications.  If closed reduction is unsuccessful, the patient will need open reduction.

Trivia:  What song does the band AC/DC traditionally end each show with?

     Answer: For Those About to Rock

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