Research Article| Volume 50, ISSUE 3, P686-689, March 2019

Effect of initial emergency room imaging choice on time to hip reduction and repeat imaging

Published:January 23, 2019DOI:


      • The shift toward initial CT scanning at our institution has led to increased radiation exposure from repeat CT scans.
      • The shift toward initial CT scanning at our institution has led to avoidable delays in the reduction of hip dislocations.
      • We recommend that the AP pelvis x-ray remain part of the initial trauma assessment, consistent with current ATLS protocol.



      Hip dislocations are highly morbid injuries necessitating prompt reduction and post-reduction assessment for fracture and incarcerated fragments. Recent literature has questioned the need for initial pelvic radiographs for acute trauma patients, resulting in computed tomography (CT) scans as the initial evaluation. This study investigates the relationship between choice of pre-reduction imaging and treatment of acute hip dislocations.


      Retrospective Case-Control.


      Single Academic Level I Trauma Center.


      All acute hip dislocations from 2011 to 2016 were reviewed. Exclusion criteria were diagnosis of dislocation at another facility, death prior to reduction, emergent surgical or ICU intervention, and periprosthetic dislocation. Patients were grouped by those with only a radiograph prior to reduction, Group I, versus those with a pre-reduction CT scan, Group II. The primary outcomes were time to reduction and the acquisition of a second CT scan.


      Of the 123 hip dislocations identified, 35 patients were excluded, mostly for transfer with a known dislocation. Group I included 29 patients and Group II included 59 patients. The mean time to reduction was 74 min in Group I and 129 min in Group II for a difference of 55 min (p < 0.001). The rate of repeat CT scan was 0 in Group I versus 48 (81%) in Group II (p < 0.001).


      Initial trauma pelvic radiography prior to CT is still important in the setting of suspected hip pathology to decrease time to hip reduction and unnecessary radiation exposure.

      Level of evidence

      Prognostic Level III.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Baird R.
        • Schobert W.
        • Pais M.
        • et al.
        Radiographic identification of loose bodies in the traumatized hip joint. - PubMed - NCBI.
        2018 (Accessed 4 January 2018)
        • Ebraheim N.A.
        • Savolaine E.R.
        • Skie M.C.
        • Hoeflinger M.J.
        Soft-tissue window to enhance visualization of entrapped osteocartilaginous fragments in the hip joint.
        Orthop Rev. 1993; 22: 1017-1021
        • Harley J.D.
        • Mack L.A.
        • Winquist R.A.
        CT of acetabular fractures: comparison with conventional radiography.
        AJR Am J Roentgenol. 1982; 138: 413-417
        • Mack L.A.
        • Harley J.D.
        • Winquist R.A.
        CT of acetabular fractures: analysis of fracture patterns.
        AJR Am J Roentgenol. 1982; 138: 407-412
        • Sauser D.D.
        • Billimoria P.E.
        • Rouse G.A.
        • Mudge K.
        CT evaluation of hip trauma.
        AJR Am J Roentgenol. 1980; 135: 269-274
        • Smith G.R.
        • Loop J.W.
        Radiologic classification of posterior dislocations of the hip: refinements and pitfalls.
        Radiology. 1976; 119: 569-574
        • Walker R.H.
        • Burton D.S.
        Computerized tomography in assessment of acetabular fractures.
        J Trauma. 1982; 22: 227-234
        • Hougaard K.
        • Lindequist S.
        • Nielsen L.B.
        Computerised tomography after posterior dislocation of the hip.
        J Bone Joint Surg Br. 1987; 69: 556-557
        • Soto J.R.
        • Zhou C.
        • Hu D.
        • Arazoza A.C.
        • Dunn E.
        • Sladek P.
        Skip and save: utility of pelvic x-rays in the initial evaluation of blunt trauma patients.
        Am J Surg. 2015; 210 (discussion 1079-1081): 1076-1079
        • Guillamondegui O.D.
        • Pryor J.P.
        • Gracias V.H.
        • Gupta R.
        • Reilly P.M.
        • Schwab C.W.
        Pelvic radiography in blunt trauma resuscitation: a diminishing role.
        J Trauma. 2002; 53: 1043-1047
        • Obaid A.K.
        • Barleben A.
        • Porral D.
        • Lush S.
        • Cinat M.
        Utility of plain film pelvic radiographs in blunt trauma patients in the emergency department.
        Am Surg. 2006; 72: 951-954
        • Kessel B.
        • Sevi R.
        • Jeroukhimov I.
        • et al.
        Is routine portable pelvic X-ray in stable multiple trauma patients always justified in a high technology era?.
        Injury. 2007; 38: 559-563
        • Brav E.A.
        Traumatic dislocation of the hip: army experience and results over a twelve-year period.
        JBJS. 1962; 44: 1115
        • Sahin V.
        • Karakaş E.S.
        • Aksu S.
        • Atlihan D.
        • Turk C.Y.
        • Halici M.
        Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study.
        J Trauma. 2003; 54: 520-529
        • Hougaard K.
        • Thomsen P.B.
        Coxarthrosis following traumatic posterior dislocation of the hip.
        J Bone Joint Surg Am. 1987; 69: 679-683
        • Dreinhöfer K.E.
        • Schwarzkopf S.R.
        • Haas N.P.
        • Tscherne H.
        Isolated traumatic dislocation of the hip. Long-term results in 50 patients.
        J Bone Joint Surg Br. 1994; 76: 6-12
        • Wiest P.W.
        • Locken J.A.
        • Heintz P.H.
        • Mettler F.A.
        CT scanning: a major source of radiation exposure.
        Semin Ultrasound CT MR. 2002; 23: 402-410
        • Smith-Bindman R.
        • Lipson J.
        • Marcus R.
        • et al.
        Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.
        Arch Intern Med. 2009; 169: 2078-2086
        • Wylie J.D.
        • Jenkins P.A.
        • Beckmann J.T.
        • Peters C.L.
        • Aoki S.K.
        • Maak T.G.
        Computed tomography scans in patients with young adult hip pain carry a lifetime risk of malignancy.
        Arthroscopy. 2018; 34 (e3): 155-163
        • Hilty M.P.
        • Behrendt I.
        • Benneker L.M.
        • et al.
        Pelvic radiography in ATLS algorithms: a diminishing role?.
        World J Emerg Surg. 2008; 3: 11
        • Carr B.G.
        • Reilly P.M.
        • Schwab C.W.
        • Branas C.C.
        • Geiger J.
        • Wiebe D.J.
        Weekend and night outcomes in a statewide trauma system.
        Arch Surg. 2011; 146: 810-817
        • Dybdal B.
        • Svane C.
        • Hesselfeldt R.
        • Steinmetz J.
        • Sørensen A.M.
        • Rasmussen L.S.
        Is there a diurnal difference in mortality of severely injured trauma patients?.
        Emerg Med J. 2015; 32: 287-290
        • Mackenzie M.J.
        • Hiranandani R.
        • Wang D.
        • Fung T.
        • Lang E.
        Determinants of computed tomography head scan ordering for patients with low-risk headache in the emergency department.
        Cureus. 2017; 9: e1760