SonoStudies: US for hip dislocations, septic hips, and fascia ilaca block for hip fractures

Quite a few recent studies on bedside ultrasound have focused on the hip, as it should, since it is so darn hard to evaluate it by the physical exam alone. Well, not only could ultrasound be used for diagnosing hip dislocations (as evidenced by the below case report), but it is also great for evaluating septic hip joints by visualizing the effusions and helping in its arthrocentesis needs … well as using ultrasound for ultrasound-guided fascia iliaca compartment block for hip fractures (especially in the elderly who you’d rather not give a ton of opiates to). – These are all from the Journal of EM.

The first case report discusses a 51 yr old man who was brought in the ED 20 minutes after a fall on wet grass while playing basketball (I know -good for him for staying active!). The current standard of care is to order an Xray. But, sometimes the Xray will not give you the information you need and you may go to CT, or the radiology tech is busy with traumas or other inpatient needs. In this case, the Ap Pelvis XR was normal. Well, never fear – the ultrasound is here! The diagnosis was made of an anterior hip dislocation by ultrasound. See the image below of his dislocated Right hip and normal Left hip when they used their curvilinear probe in anterior, mid-axial and coronal planes:

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Another case report recently published discusses an 18 yr old female c/o 5 days of hip pain radiating down her anterior thigh and worse with weight bearing and hip movement. No fevers or other symptoms… oh, and she is 23 weeks pregnant. Now, the diagnosis of septic hips is a clinical one yet, sometimes, it can fool the best of us. I know Ive seen a patient with a septic hip walk…yes, with a limp, but still walk… saying “I think I just twisted it.” She was a bounce back to the (different) ED for persistent hip pain after an US was negative for DVT. She had mild leukocytosis (but what pregnant patient doesn’t!?!). The ED docs took a look with their ultrasound machine and saw an effusion (top picture below) (compared it to the opposite a-symptomatic hip (bottom picture below)) and then performed an ultrasound-guided arthrocentesis of purulent fluid: arrow and closed arrow is the femoral head and neck, respectively.

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For a great podcast, the only way they know how to make it even more enjoyable – check out UltrasoundPodcast insert for hip ultrasund, aspiration and injection.

Now, the last study I will highlight, is one that is a more common concept/indication for hip issues – the fascia iliaca block for hip fractures. “”Hip fracture (HFx) is a painful injury that is commonly seen in the emergency department (ED). Patients who experience pain from HFx are often treated with intravenous opiates, which may cause deleterious side effects, particularly in elderly patients. An alternative to systemic opioid analgesia involves peripheral nerve blockade”  – word! A small study showing a decrease in pain scale in over 75% of the patients:

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