Reachout Orthopedics - Issue 1

with appropriate analgesia, the dislocation was reduced in the emergency room using traction and external rotation of the right lower limb (Fig. 2). Post-intervention radiographs confirmed successful reduction. A computed tomography (CT) scan of the pelvis confirmed the posterior wall fracture of the acetabulum (Figs. 3, 4). Two days past the injury, the patient underwent surgery where an open reduction and internal fixation of the acetabular fracture with two lag screws was performed using Kocher-Langenbeck approach (Fig. 5). The patient had an uneventful postoperative course and was discharged with instructions for non-weight bearing for 6 weeks. On the 3-month follow-up, the patient was pain free, had full range of hip motion and was allowed full weight bearing. On the 12-month follow-up, the patient was still pain free and hip range of motion was normal compared to the contralateral hip. The radiologic examination of the pelvis showed no signs of either femoral head avascular necrosis or hip joint degeneration, and the patient was no further withheld from any former daily routine and sporting activities (Fig. 6). Discussion Hip dislocations are an orthopaedic emergency, and their immediate recognition and treatment is vital for their prognosis [11]. Traumatic hip dislocations are high energy injuries and most commonly occur during car accidents when the knee strikes the dashboard [5]. Hip dislocations as a result of sports injuries are extremely rare, accounting for 2–5% of all hip dislocations [2]. They have been reported in rugby, basketball and biking, while only six cases have been reported in football [7, 10, 12]. The most commonly reported mechanisms for posterior hip fracture-dislocation in sports are either a forward fall on the knee with the hip flexed or a blow from behind when the athlete is down on all four limbs [2]. Despite the fact that minimal force is involved, possible complications remain the same. Major complications of traumatic hip dislocation include avascular necrosis of femoral head, secondary osteoarthritis, sciatic nerve injury and heterotopic ossification. The incidence of avascular necrosis of the femoral head varies from 10 to 20% and increases when the reduction is delayed for more than 6 hours from the time of injury [1]. Delayed hip reduction is also an important factor for the development of post-traumatic osteoarthritis. Upadhyay et al . reported that degenerative hip arthritis occurs in 16% of hip dislocations without a fracture and 88% of hip fracture-dislocations [12]. Sciatic nerve injury is directly associated with delayed reduction with an impact of 0–20%, as reported by Cornwell and Radomisli [3]. A review of the literature by Giannoudis et al . [6] retrieved only one Fig. 1: Pre-reduction radiograph: anteroposterior plain radiograph of the pelvis showing dislocation of the right femoral head and fracture of the pos- terior wall of the acetabulum. Fig. 3: Computed tomography of the pelvis: axial view showing a fracture of the posterior wall of the acetabulum. Fig. 4: Computed tomography of the pelvis: coronal view showing a fracture of the posterior wall of the acetabulum. Fig. 2: Post-reduction radiograph: anteroposterior plain radiograph of the pelvis showing successful hip reduction. Cont'd on page 20... 17