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Associated Injuries w/ Posterior Hip Dislocations

- 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 IR 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 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;
               - right hip dislocation was initially missed on the portable x-ray, probably as a consequence of a poor quality x-ray along w/ 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


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