Wednesday Image Review

What’s the Diagnosis? By Dr. Carlos Cevallos

Case: A 60 year old female with a past medical history of a left hip replacement presents with a chief complaint of left hip pain after a fall. Since the fall she has been unable to move her hip and on exam the left leg is visibly shortened, adducted, and internally rotated, otherwise the patient is neurovascularly intact. X-ray reveals the image below. What’s the diagnosis?

Answer: Posterior Hip Dislocation

Case Continued: Under procedural sedation with keto-fol the hip was reduced successfully using the Captain Morgan technique as demonstrated in post-reduction XRs below. The patient was then placed in a knee immobilizer and discharged with an abduction pillow and orthopedic follow up.

  • Over 90% of hip dislocations are posterior
  • Up to 10% of prosthetic hips undergo dislocation with the vast majority being posterior
  • Native hip dislocations are an orthopedic emergency and should be reduced as soon as possible!
    • The risk of avascular necrosis increases from <10% to about 25%  when reduction is extended from 10 hours to 15 hours
    • Prosthetic hip dislocation is not as time sensitive as there is no blood flow to the joint, thus no risk of avascular necrosis.
    • Sciatic nerve injury can occur in both native and prosthetic posterior hip dislocations
  • There are many different reduction techniques including but not limited to:
  • A CT should be obtained post-reduction of native hips to rule out fractures/loose debris


Tintinalli’s Emergency Medicine Cases A comprehensive Study Guide 9th Edition, Judith Tintinalli

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