Essay Example on Hip dislocations are infrequent occurring almost Always








Hip dislocations are infrequent occurring almost always after a traumatic injury 85 to 90 of these are posterior dislocations Dislocations of the hip including a spectrum of injuries that have considerable potential for long term disability and rapidly progressing joint degeneration To dislocate a hip requires massive force Associated injuries are common and should be screened These include fractures of the femoral head femoral neck acetabulum or a combination of these Time to presentation and more importantly reduction of the hip dislocation is essential in treating this injury and minimizing long term complications such as avascular necrosis and posttraumatic arthritis Small cartilaginous or osseous fragments may remain in the joint space preventing a congruent reduction In addition the vascular supply to the femoral head may be irreversibly damaged at the time of the injury These associated injuries can compromise the likelihood of maintaining a normally functioning hip joint Sciatic nerve injuries and trauma to more distal aspects of the ipsilateral extremity trauma can affect management and outcome of patients who sustain a hip dislocation

According to De Lee J C 1996 the mechanism of dislocation of the hip has been shown in multiple case studies to be axial loading most commonly secondary to impact with a dashboard in a motor vehicle crash The direction of the dislocation is dependent on the position of the hip at impact and the direction of the force vector applied The impact on the knee with the hip in an adducted position leads to a posteriorly directed force causing a posterior dislocation In contrast an anterior dislocation occurs when the hip is abducted and externally rotated 2 CASE STUDY Patient Mr P 34 years old Indonesian male not known medical illness Patient brought in to yellow zone by PHC team via stretcher Patient was alleged motor vehicle accident motorbike versus car around 5am today Patient was riding motorbike with helmet A car drove fast and suddenly drove into his lane and hit him On arrival patient was alert conscious with Glasgow coma scale GCS 15 15 Patient was in sustained pain with wound over right leg and right arm both side was splinted Vital sign on arrival temperature was normal BP 128 80 mmHg PR 91 bpm and pain score was 7 10 Otherwise no loss of consciousness no ear nose and throat bleeding and no vomiting Primary survey completely done Airway Speaking in full sentences no stridor and gurgling tracheal centrally located and cervical collar was applied Breathing Symmetrical chest rise no open wound seen respiration rate is 18bpm chest spring negative air entry equal and good on auscultation Circulation Warm peripheries capillary refill time CRT less than 2 sec good pulse volume abdomen is soft and no tender no open wound seen and pelvic spring negative Disability Glasgow Coma Scale GCS 15 15 pupils 3mm reactive bilaterally Exposure Patient is equally exposed and covered Log roll done no step deformity no open wound no spinal tenderness anal tone intact no spike of bone no high riding or prostate full neck ROM range of motion no indication for CT brain able to lift left upper limb and lower limb but shortening if right leg

After complete the primary survey proceed with secondary survey On assessment no neck tenderness deep laceration wound over extensor aspect of right elbow communicating with elbow joint exposed soft tissue but no active bleeding Noted deep laceration wound over anterolateral aspect of right knee region communicating with knee joint oozing of blood but stopped with compression Then superficial laceration wound over dorsum region of right foot exposed tendon but no tendon cut Full range of motion of toes and ankle Lastly punctured wound seen over anterolateral aspect of left knee but no active bleeding Fast scan done and no free fluid intra abdominally Plan for patient IM ATT anti tetanus stat Branula inserted and administer drip maintenance since patient don t have any sign of shock IV Morphine 3mg stat given to reduce the pain IV maxolon 10mg and start antibiotic for prophylaxis since patient have open wound IV Cefuroxime 1 5mg and IV Flagyl 500mg stat given Sent patient for cervical chest pelvic right elbow ulna radius wrist upper limb x ray and also right femur knee tibia fibula ankle foot lower limb x ray After x ray done the report shows right anterior hip dislocation open fracture proximal 1 3 right ulna and closed fracture distal 1 3 right fibula Patient was slinted at fracture site Decided to do close reduction CMR on right hip under sedation Reduction done on right hip with sedation of IV fentanyl 100mg and propofol 100mg Case referred to orthopaedic team for further management Reviewed by Ortho team at emergency department and continue treatment as ordered Add IV Gentamycin 240mg stat and for wound irrigation Repeat pelvic X ray post reduction of the hip Continue monitoring of the patient and admit to orthopaedic ward for surgical intervention later

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