Monday, June 16, 2008


A patient rolls into your ER in the characteristic position shown above. Unfortunately, he was a passenger in the front seat of a car which got rear-ended. A neurologic exam shows hypesthesia over the dorsum of the foot and weakness in dorsiflexion. You get an X-ray, shown below.

Challenge: What happened?

Images shown under fair use.


Alex said...

common fibular nerve palsy? femur dislocated?

Craig said...

Pretty close; this was a hard one.

This is a posterior dislocation of the hip most commonly caused by a direct blow on the knee as it strikes the dashboard in an automobile accident. The femoral head is driven posteriorly which can fracture the posterior lip of the acetabulum. The patient presents with the leg flexed, adducted, and internally rotated. The neurologic defect represents damage to the peroneal component of the sciatic nerve.