This document summarizes the case of a 41-year-old man who was in a car accident where he hit a tree with his console but did not hit his head. He reported right hip pain after the accident and could not walk or move his right leg. On examination, he had marked tenderness over his right hip with limited and painful range of motion. He was taken to the OR for closed reduction of a posterior hip dislocation under general anesthesia. Potential complications of posterior hip dislocations include osteonecrosis, osteoarthritis, and sciatic nerve injury.

1. Extern conference
Ext.ธนนันท ตันตยากร

2. CC: ปวดสะโพกขวา 5 ชั่วโมง
ชาย 41 ป
1977865

3. Primary survey, At ER
A: Can speak, no C-spine tenderness, full ROM of neck
B: Trachea in midline, Equal breath sound, both lungs
C: BP 132/77 mmHg, PR 86 bpm
D: E4V5M6, pupil 3 mm RTLBE
E: Rt. thigh flexion-adduction-internal rotation, Marked tender Rt.hip area, Abrasion
wound 2x2 cm Lt. knee

7. Secondary survey
A: none
M: none
P: none
L: NPO 6hr, อาหาร
E: ขับรถกระบะชนตนไม เขากระแทกคอนโซลรถ ไมมีศีรษะกระแทก ปฏิเสธประวัติหมดสติ
ไมมีคลื่นไสอาเจียน มีประวัติดื่มสุรา หลังเกิดเหตุปวดสะโพกขวามาก เดินไมได ขยับขาขวา
ไมได

8. Physical Examination
Extremity:
Rt.thigh flexion-adduction-internal rotation, Marked tender Rt.hip area, Limit
Active ROM Rt. hip due to pain
Rt.knee no external wound, no swelling, not tender, limit active ROM due to
Rt.hip pain, full passive ROM
Rt.ankle active dorsiflexion and plantar flexion
Rt.DPA 2+, Rt.PTA 2+
Intact pinprick sensation

12. Management
Set OR for Close reduction under GA

15. Posterior Hip Dislocation

22. Thompson-Epstein
classification of hip dislocations

23. https://www.youtube.com/watch?v=eMVsjwAukU4

25. Management after reduction
● Stability test of the hip joint
● Re-access neurovascular function
● Immobilization
● Plain radiograph / CT scan

26. Indication for Open reduction
● Irreducible dislocation
● Iatrogenic sciatic nerve injury
● Incongruent reduction with incarcerated fragment
● Incongruent reduction with soft tissue interposition
● Fracture dislocation of femoral head

27. The possible complication
● Osteonecrosis : reported 5 – 40 %
Directly relate with the time to reduce
Less than 6 hours : reported 0 - 7%
● Osteoarthritis : reported 26 – 50 %
● Sciatic nerve injury : reported 10 – 20 %