Inferior hip dislocations are the least common form of hip dislocation. They require a high energy mechanism of injury and are often associated with other traumatic limb and life threatening injuries. This article reviews the case of a 16 year old male who presented to the emergency department (ED) following a high speed motor vehicle crash. On arrival he was diagnosed with a right inferior hip dislocation among other critical findings. This case report provides a brief literature review of this poorly studied clinical entity and seeks to educate physicians providing emergency, traumatic, orthopedic or critical care to patients who present with acute inferior hip dislocations.
Hip Dislocation/diagnosis , Accidents, Traffic , Adolescent , Emergency Service, Hospital , Hip Dislocation/diagnostic imaging , Hip Dislocation/etiology , Humans , Male , Radiography
There are no data-supported recommendations on how proximal is too proximal for retrograde nailing (RGN). At six level 1 trauma centers, patients with femur fractures within the proximal one-third of the femur treated with RGN were included. This article describes a proximal segment capture ratio (PSCR) and nail segment capture ratio to evaluate RGN of proximal fractures. The study included 107 patients. The average follow-up was 44 weeks. There were two nonunions and three malunions. There was no significant difference between PSCR of 0.3 or less and need for secondary procedures or time to full weight bearing (p>.05). In this study, a smaller (< 0.3) PSCR was not associated with an increased number of complications. A higher Orthopaedic Trauma Association classification was predictive of malunion and increased time to union. These data demonstrate that retrograde nailing is safe and effective for the treatment of supraisthmal femur fractures.
Bone Nails , Femoral Fractures/surgery , Fracture Fixation, Intramedullary/methods , Fractures, Malunited/epidemiology , Fractures, Ununited/epidemiology , Accidental Falls , Accidents, Traffic , Adolescent , Adult , Aged , Female , Humans , Injury Severity Score , Male , Middle Aged , Pedestrians , Recovery of Function , Retrospective Studies , Treatment Outcome , Weight-Bearing , Young Adult
PURPOSE OF REVIEW: This review provides historical background on trauma care in the USA and summarizes contemporary trauma-related health policy issues. It is a primer for orthopedic surgeons who want to promote improvements in research, delivery, and cost reduction in trauma care. RECENT FINDINGS: As of 2010, funding for trauma research accounted for only 0.02% of all National Institutes of Health research funding. This is disproportionate to the societal burden of traumatic injury, which is the leading cause of death and disability among people aged 1 to 46 years in the USA. The diagnosis-related group model of hospital reimbursement penalizes level-I trauma centers, which typically treat the most severely injured patients. Treatment of traumatic injury at level-I and level-II trauma centers is associated with lower rates of major complications and death compared with treatment at non-trauma centers. Patient proximity to trauma centers has been positively correlated with survival after traumatic injury. Inadequate funding has been cited as a reason for recent closures of trauma centers. Orthopedic surgeons have a responsibility to engage in efforts to improve the quality, accessibility, and affordability of trauma care. This can be done by advocating for greater funding for trauma research; choosing the most cost-effective, patient-appropriate orthopedic implants; supporting the implementation of a national trauma system; leading high-quality research of trauma patient outcomes; and advocating for greater accessibility to level-I trauma centers for underserved populations.
