Radiology Review

More Than His Car Is Bent Out of Shape

Clinician Reviews. 2019 April;29(4):3e-4e
Author(s):
Nandan R. Hichkad, PA-C, MMSc
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More Than His Car Is Bent Out of Shape

A 30-year-old man is brought to your emergency department as a trauma code following a car accident. The patient was an unrestrained driver who lost control of his car and crashed into a telephone pole. There was significant damage to the front half of the vehicle, which led to a prolonged extrication time.

Upon arrival, he is immediately intubated because emergency personnel had difficulty intubating him in the field. He has a Glasgow Coma Scale score of 3T. The patient’s blood pressure is 90/40 mm Hg and his heart rate, 150 beats/min. He appears to have deformities in his lower extremities.

You obtain portable radiographs of the chest and pelvis. The latter is shown. What is your impression?


 

More Than His Car Is Bent Out of Shape

ANSWER

The radiograph demonstrates bilateral hip dislocations. On the right, the femoral head appears to be posteriorly dislocated and slightly internally rotated. On the left, the femoral head appears to be anteriorly and superiorly dislocated (although evaluation is limited by a single view). Neither side appears to have any obvious fractures.

The patient’s dislocations were promptly reduced in the trauma bay by the orthopedic service before he was sent for CT.

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