Answer
1) Plain radiograph
- AP view of the pelvic plain radiograph
- Adequate exposure and penetration
- Shenton line is disturbed/ not preserve
- Left acetabulum is not intact
- Multiple small fragmented bone noted at left hip area
- Head of left femur is displaced superiorly.
2) Injury occur when patient’s hip and knee are both in flex position. The impact is transmitted through the patella, patellofemoral joint, femur and hip joint to the posterior lip of the acetabulum which is a thin bone and not prepared for the force.
3) Fracture dislocation of the left hip joint.
4) Patella fracture, damage to articular surface of femur, ruptured posterior cruciate ligament, fractured femur.
5) Damage to sciatic nerve, aseptic necrosis of the femoral head, ectopic ossification around the hip joint, limb shortening, osteoarthritis.
6) Management to this patient
- Triage the patient
- Access airway, breathing and circulation
- Blood investigation (FBC, GSH, PT/aPTT, RFT)
- Plain radiograph of the chest and spine.
- Pain management with opiod base drug.
- Full assesment of neurological function before and after reduction
- Reduction of the dislocation within 4-6 of injury and hold with tration
- Open reduction if difficult close reduction to avoid damage to sciatic nerve.
- Definitive management based on stability of the hip joint
a) Bed rest for 2-3 week if hip stable and acetabular fragment small
b) Bed rest for 6-8 week if unstable but acetabular in good position
c) Surgical intervention if there is large single fragment, fragment in poor position and hip is unstable.
1) Plain radiograph
- AP view of the pelvic plain radiograph
- Adequate exposure and penetration
- Shenton line is disturbed/ not preserve
- Left acetabulum is not intact
- Multiple small fragmented bone noted at left hip area
- Head of left femur is displaced superiorly.
2) Injury occur when patient’s hip and knee are both in flex position. The impact is transmitted through the patella, patellofemoral joint, femur and hip joint to the posterior lip of the acetabulum which is a thin bone and not prepared for the force.
3) Fracture dislocation of the left hip joint.
4) Patella fracture, damage to articular surface of femur, ruptured posterior cruciate ligament, fractured femur.
5) Damage to sciatic nerve, aseptic necrosis of the femoral head, ectopic ossification around the hip joint, limb shortening, osteoarthritis.
6) Management to this patient
- Triage the patient
- Access airway, breathing and circulation
- Blood investigation (FBC, GSH, PT/aPTT, RFT)
- Plain radiograph of the chest and spine.
- Pain management with opiod base drug.
- Full assesment of neurological function before and after reduction
- Reduction of the dislocation within 4-6 of injury and hold with tration
- Open reduction if difficult close reduction to avoid damage to sciatic nerve.
- Definitive management based on stability of the hip joint
a) Bed rest for 2-3 week if hip stable and acetabular fragment small
b) Bed rest for 6-8 week if unstable but acetabular in good position
c) Surgical intervention if there is large single fragment, fragment in poor position and hip is unstable.