Hip Injury-football

Abstract

HISTORY: A 22 year-old college football tight end sustained an acute hip injury during a regular season practice. After receiving a pass from the quarterback, he was tackled from the right side and forcefully pushed to the ground. Initially, he reported only that he had twisted his leg and denied any axial load. However, subsequent review of the video revealed that he fell forward directly onto his right knee with the right hip flexed to 90 degrees and some internal rotation and adduction caused by the weight of the tackling opponent. He later described feeling a pop and a shifting sensation during the event. Although able to ambulate immediately afterward, he reported moderate posterior hip and groin pain, and was removed from practice. PHYSICAL EXAM: Initial sideline and serial training room examinations revealed a mildly antalgic gait, normal appearance of the right lower extremity, and no tenderness to palpation. Pain was elicited with hip flexion to exactly 90 degrees, but passive range of motion was full. There was pain with simultaneous passive flexion, adduction and internal rotation. The neurovascular exam was intact without signs of sciatic injury. The knee exam was unremarkable. DIFFERENTIAL: Musculotendinous Strain (Gluteal, Adductors, Iliopsoas) Contusion Fracture (Acetabular or Femoral Neck) Hip Dislocation/Subluxation Hip Labral Tear Avulsion Injury TEST AND RESULTS: AP, Frog leg lateral, and Judet x-rays views of the pelvis and right hip: minimally displaced fracture of the posterior rim of the right acetabulum without evidence of dislocation CT lower extremity without contrast: normal seating of the femoral head within its acetabulum essentially undisplaced fracture through the posterior rim of the acetabulum no intra-articular fragments femoral head and neck intact FINAL/WORKING DIAGNOSIS: Posterior Hip Subluxation with resulting Posterior Rim Acetabular Fracture TREATMENT AND OUTCOMES: 1. Made non-weight bearing on the night of the injury while awaiting x-ray. 2. Following imaging confirmation, initiated toe-touch weight bearing with crutches for six weeks. 3. Avoid hip flexion past 90 degrees and internal rotation. 4. Early mobilization exercises initiated during the first week post injury.