Click on hyperlinked text to view radiographs and clinical pictures.

Introduction

A 30 year old man was involved in a motor vehicle accident.  He was riding his motorcycle and was cut off by a car which ran across the front of his motorcycle.  As a result, he ended up hitting the passenger's side of the car head-on.  He was wearing a helmet and did not suffer any head trauma.   He is brought into the trauma room immobilized on a long spine board and with a C-collar on.  He complains of extreme bilateral hip, groin, and thigh pain.   Primary survey in the trauma room reveals that he is stable and has suffered bilateral hip injuries.  Luckily, he is neurovascularly intact.  His pelvic radiograph is shown below.

AP Pelvis Radiograph in Trauma Room:

pre_ap.jpg (21718 bytes)  

What is your diagnosis ?

How would you manage this patient in the trauma room ?

After IV conscious sedation in the trauma room, a closed reduction of both hips is carried out.

Post Reduction Views in Trauma Room:

post_lh.jpg (17099 bytes)  post_rh.jpg (19146 bytes)  

Are both hips adequately reduced ?

What investigations should you perform now ?

Management  

The right hip remained subluxed post reduction.  In order to identify any structures which may have been blocking the reduction, a CT scan was done.  

CT Pelvis (Fine Cuts):


ct1_sblx.jpg (38732 bytes)  ct2_sblx.jpg (41529 bytes)  

The patient was taken to the operating room for an open reduction of the right hip.  The left hip was allowed to heal in-situ and an ORIF was not carried out.  Postoperative radiographs showed excellent reductions and the long-term result of the left femoral head fracture is excellent.  

Postoperative Radiographs of Pelvis and Hips:


post_bh.jpg (22164 bytes) p_l_rh.jpg (11667 bytes)
post_rh.jpg (19146 bytes)   ap_lh.jpg (16103 bytes)  p_l_lh.jpg (11833 bytes)

 

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