Description
A 28-year-old man attended the emergency department following an awkward tackle while playing rugby. While in the prone position, another player landed on his lower back.1 2 He experienced immediate pain in association with a ‘popping’ sensation in his left hip. In the emergency department there was no obvious pelvic or lower limb deformity. He was able to straighten his leg and raise both the legs. He demonstrated only mild tenderness in his left groin and a slight reduction in the left hip flexion and abduction. He was unable to bear weight. For these reasons, pelvis and lateral hip radiographs were requested. These demonstrated a posterior dislocation of the femoral head with an associated acetabular rim fracture (figure 1).
Figure 1.
A radiograph of the pelvis demonstrates a posterior dislocation of the femoral head with an associated acetabular rim fracture.
The orthopaedic team performed a reduction of his dislocation under general anaesthesia. The postreduction pelvic radiograph was satisfactory. Further CT imaging of his hip was requested to further evaluate the joint. It demonstrated a comminuted fracture at the posterior-superior acetabular rim (figure 2). A small bone fragment was also demonstrated at the anterior-inferior rim of the acetabulum with the proximal femur appearing intact. Follow-up in an orthopaedic clinic to date has been satisfactory.
Figure 2.
CT of the hip shows a comminuted fracture at the posterior-superior acetabular rim. A small bone fragment is shown at the anterior-inferior rim.
This was an unusual case as the mechanism of injury rarely results in such a significant injury. In addition, the patient had few clinical signs which initially led the team to believe he had a much less severe injury.
Learning points.
Posterior hip dislocations are more commonly seen following road traffic collisions and are rarely a result of athletic injuries.
Usually posterior hip dislocations are extremely painful due to the displaced femoral head resting on the sciatic nerve and present with flexion, internal rotation and adduction of the affected hip.
Early orthopaedic involvement should be sought with the aim to achieve a timely reduction.
Footnotes
Competing interests: None.
Patient consent: Obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.
References
- 1.Venkatachalam S, Heidari N, Greer T. Traumatic fracture-dislocation of the hip following rugby tackle: a case report. Sports Med Arthrosc Rehabil Ther Technol 2009;1:28. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Yang RS, Tsuang YH, Hang YS, et al. Traumatic dislocation of the hip. Clin Orthop Relat Res 1991;265:218–27 [PubMed] [Google Scholar]