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EMS brings you a 54 year old who slipped off a wet ladder rung and fell about 15 feet. He is boarded and collared by the paramedics and complains of R hip pain. Vitals are OK, and he complains of pain in his R hip area. “I can stand,” he tells you as you finish your unremarkable primary survey, “but it just hurts . . . a lot”. By exam, he has poorly localizing pain in the R hip and pelvis area, with some pain in the R hip with ROM and axial load. There is no shortening of the R leg, and the N/V exam is normal. You get a quick portable X-ray of the hip, and order the full Monty – total body CT scan – for mechanism of injury

The first portable X-ray is shown (below). What does it show? What else might be helpful?

What does the X-ray show? Answer on next page

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Comments   

# Graham 2011-02-17 07:19
Great case. Agree, the board does nothing to protect the spine. At places where they use the board for transport, we've used a gel pad that we put between patient and the board when we roll and expose them. Then they get the CT still on the board, but without the pressure ulcer risk.
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# Ed docFred bollhoffer 2011-02-18 11:26
I am not sure it would have helped but my studies on this patient would have been portable pelvis or at least a kub that opens to show the whole pelvis. Might have helped.
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