Effect of initial emergency room imaging choice on time to hip reduction and repeat imaging

Injury. 2019 Mar;50(3):686-689. doi: 10.1016/j.injury.2019.01.032. Epub 2019 Jan 23.


Objectives: Hip dislocations are highly morbid injuries necessitating prompt reduction and post-reduction assessment for fracture and incarcerated fragments. Recent literature has questioned the need for initial pelvic radiographs for acute trauma patients, resulting in computed tomography (CT) scans as the initial evaluation. This study investigates the relationship between choice of pre-reduction imaging and treatment of acute hip dislocations.

Design: Retrospective Case-Control.

Setting: Single Academic Level I Trauma Center.

Methods: All acute hip dislocations from 2011 to 2016 were reviewed. Exclusion criteria were diagnosis of dislocation at another facility, death prior to reduction, emergent surgical or ICU intervention, and periprosthetic dislocation. Patients were grouped by those with only a radiograph prior to reduction, Group I, versus those with a pre-reduction CT scan, Group II. The primary outcomes were time to reduction and the acquisition of a second CT scan.

Results: Of the 123 hip dislocations identified, 35 patients were excluded, mostly for transfer with a known dislocation. Group I included 29 patients and Group II included 59 patients. The mean time to reduction was 74 min in Group I and 129 min in Group II for a difference of 55 min (p < 0.001). The rate of repeat CT scan was 0 in Group I versus 48 (81%) in Group II (p < 0.001).

Conclusion: Initial trauma pelvic radiography prior to CT is still important in the setting of suspected hip pathology to decrease time to hip reduction and unnecessary radiation exposure.

Level of evidence: Prognostic Level III.

Keywords: ATLS; Blunt trauma; Computed tomography (CT); Hip dislocation; Pelvis radiograph.

MeSH terms

  • Adult
  • Aged
  • Case-Control Studies
  • Closed Fracture Reduction / statistics & numerical data*
  • Emergency Service, Hospital*
  • Female
  • Hip Dislocation / diagnostic imaging*
  • Hip Dislocation / pathology
  • Humans
  • Male
  • Middle Aged
  • Pelvis / diagnostic imaging*
  • Pelvis / injuries
  • Pelvis / pathology
  • Radiation Dosage
  • Retrospective Studies
  • Time-to-Treatment / statistics & numerical data*
  • Tomography, X-Ray Computed*
  • Young Adult