Pediatric emergency medicine trisk 3490 3490
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FIGURE 111.33 An unstable pelvic injury. A: On the plain film, multiple fractures of the pubic
rami (small arrows ) and widening of the right sacroiliac joint (large arrow ) are apparent. B:
On the three-dimensional reconstruction of the CT scan, the left sacroiliac fracture is even more
obvious (small arrow ), and a right-sided sacral fracture is also seen (large arrow ).
Current Evidence
For hip dislocations, the risk of osteonecrosis and posttraumatic arthritis is
increased with delays in reduction.
Clinical Considerations
Clinical Recognition. Dislocations of the hip are apparent on physical
examination with a painful, shortened limb. Proximal femur fractures present
with hip pain, inability to bear weight, and/or limp.
Triage Considerations. Patients with injuries of the hip and proximal femur are
generally hemodynamically stable, unless multisystem trauma has been sustained.
As these injuries are associated with significant pain, patients should have a brief
initial evaluation and then have pain medications administered.
Clinical Assessment. The initial assessment should include the vital signs and a
thorough examination of the abdomen, pelvis, lower extremities, and neurologic
system. A careful neurovascular examination must be performed. The presence of
the dorsalis pedis and posterior tibial artery pulses should be documented, and the
distal perfusion status of the limb should be examined. Sensory and motor nerve
function should be evaluated as follows: The posterior tibial nerve must be
assessed by evaluating sensation on the plantar aspect of the foot and by checking
plantar flexion, and the peroneal nerve must be assessed by evaluating sensation
