Delay in hip reductions due to the advent of rapid CT scans in the trauma setting

With increasing reliance on computed tomography (CT) in trauma care, the use of anteroposterior (AP) pelvis radiographs has declined. This study examined whether omitting an initial AP pelvis film affected time to hip reduction and the need for additional CT imaging in patients with traumatic hip dislocations.

We conducted a retrospective review at a Level I trauma center (2005-2016). Eligible patients were adults (> 17 years) with native hip dislocations evaluated under the Advanced Trauma Life Support (ATLS) protocol. Patients with incomplete records or irreducible hips requiring operative reduction were excluded. Data collected included patient demographics, AP pelvis use, CT imaging, time to reduction, and presence of acetabular or proximal femur fractures.

The study cohort consisted of 50 patients, 76% male (n = 38), with a mean age of 33 years (range, 18-68). High-energy motor vehicle accident or motorcycle crash accounted for 90% (n = 45) of injuries, and 94% (n = 47) were posterior dislocations. Associated fractures were present in 76% (n = 38). Patients were divided into those who had no AP pelvis radiograph prior to CT scan (N-APP group, n = 8; 16%) and those who obtained an initial AP pelvis radiograph on presentation (APP group, n = 42; 84%). All patients in the N-APP group received an additional CT pelvis scan, while none in the APP group did. Average time to reduction was significantly shorter in the APP group compared with the N-APP group (69 vs. 216 min, p < 0.05).

Obtaining an initial AP pelvis radiograph provided a rapid and reliable means of diagnosing hip dislocations. Adherence to ATLS guidelines by performing a pelvic film before CT shortened time to reduction and prevented unnecessary repeat CT imaging in adult patients with traumatic native hip dislocations.