FIGURE 111.33 An unstable pelvic injury A: On the plain film, multiple fractures of the pubic rami (small arrows ) and widening of the right sacroiliac joint (large arrow ) are apparent B: On the three-dimensional reconstruction of the CT scan, the left sacroiliac fracture is even more obvious (small arrow ), and a right-sided sacral fracture is also seen (large arrow ) Current Evidence For hip dislocations, the risk of osteonecrosis and posttraumatic arthritis is increased with delays in reduction Clinical Considerations Clinical Recognition Dislocations of the hip are apparent on physical examination with a painful, shortened limb Proximal femur fractures present with hip pain, inability to bear weight, and/or limp Triage Considerations Patients with injuries of the hip and proximal femur are generally hemodynamically stable, unless multisystem trauma has been sustained As these injuries are associated with significant pain, patients should have a brief initial evaluation and then have pain medications administered Clinical Assessment The initial assessment should include the vital signs and a thorough examination of the abdomen, pelvis, lower extremities, and neurologic system A careful neurovascular examination must be performed The presence of the dorsalis pedis and posterior tibial artery pulses should be documented, and the distal perfusion status of the limb should be examined Sensory and motor nerve function should be evaluated as follows: The posterior tibial nerve must be assessed by evaluating sensation on the plantar aspect of the foot and by checking plantar flexion, and the peroneal nerve must be assessed by evaluating sensation