Missed posterior dislocation of the hip in a head-injured patient with seven long bones’ fractures – A case report and observed clinical-radiological signs

Abstract

Background: Head injury increases the risk of missed diagnosis by making patient-derived history impossible. The risk of missing a posterior dislocation of the hip in a head-injured patient is aggravated when an ipsilateral femoral shaft fracture co-exists. Adequate radiological evaluation of bone and joints is therefore of critical value in avoiding missed diagnosis of osteo-articular conditions in such patients.

Case Report: We present a young female with head injury along with fractures of the tibiae and fibulae, the left femur and humerii and a closed posterior dislocation of the left hip from a road traffic accident. Literature search revealed no previous report of seven long bone fractures, hip dislocation and head injury in the same patient. The value of this case is in re-iterating the need to look out for missed diagnosis in the multiply injured and the role of unsual displacement of diaphyseal femoral fracture fragments in aiding diagnosis.

Conclusion: This case report serves the dual role of re-iterating the need for x-rays of joints related to a fractured bone and presenting a valuable radiologic sign in the prevention of missed posterior dislocation of the hip in patients with ipsilateral femoral shaft fracture.

Keywords: Missed Diagnosis; Posterior Hip Dislocation; Ipsilateral Femur Fractures; Clinical/Radiological Signs.