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<< Managing Dislocations of the Hip, Knee, and Ankle in the Emergency Department (Trauma CME)

Risk Management Pitfalls in Management of Lower-Extremity Dislocation

1. “I didn't consider injuries other than hip dislocation.”

Hip dislocation may be a distracting injury; 95% of patients have other associated injuries. Be sure to perform a thorough trauma evaluation, and maintain a low threshold for ordering imaging on any suspected injury.

6. “I didn't think I needed to consult orthopedics to see the patient before discharging him from the ED.”

Even if reduction is successful, patients can still have complications from their injuries. If the patient's neurovascular status is abnormal, or there is a nonconcentric reduction, they may still require emergent orthopedic consultation and open reduction and internal fixation.

9. “The reduction went smoothly, and the pain was much relieved, so I didn’t pursue further imaging.”

Because of the risk of other, associated fractures, CT should be obtained following all native hip reductions to assess for loose fragments and femoral neck, femoral head, or acetabular fracture. CT should also be obtained for many ankle dislocations.

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