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Image challenge
Is a hip flip the right trick?
  1. Leonoor Neline Tess Oerlemans1,
  2. Wierd P Zijlstra1,
  3. Heleen Lameijer2,
  4. Constant W Coolsma2
  1. 1 Department of Orthopedic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
  2. 2 Department of Emergency Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
  1. Correspondence to Dr Heleen Lameijer, Emergency Department, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands; heleen.lameijer1{at}znb.nl

Abstract

Clinical introduction A 68-year-old man, with known spasticity and a total left hip arthroplasty (THA) performed 6 years ago, was brought to our ED after falling down the stairs. Laying on the stretcher, his left leg was internally rotated and in hyperflexion. An X-ray of the left hip was performed. The diagnosis of posterior hip dislocation was made (figure 1). The patient received sedation and analgesia with 75 mg propofol and 9 mg esketamine intravenously, and a closed reduction procedure was attempted using manual flexion, adduction, traction and internal rotation. Unfortunately, the reduction failed.

Figure 1
Figure 1

The patient’s X-ray.

Question Why is closed reduction not effective in this case?

  1. The femoral head is located more cranially expected, due to material failure. The whole THA should be replaced.

  2. This is an anterior dislocation. The closed reduction procedure should be performed by using extension, abduction, traction and internal rotation.

  3. The femoral head is not reduced centrally in the acetabulum and the closed reduction procedure should be repeated more forcefully.

  4. A dual-mobility cup is used and the liner is not in place anymore. Revision surgery is required.

For answer see page 2

  • dual-mobility cup
  • total hip arthroplasty
  • intra-prosthetic dislocation
  • reduction

https://doi.org/10.1136/emermed-2019-208932

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    Footnotes

    • Contributors The authors have contributed equally.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.