Bilateral Thigh Pain
Author:
Theresa M. Blase, MD
Affiliations:
Department of Emergency Medicine
St. John's Mercy Medical Center
St. Louis, MO
Chief Complaint:
Bilateral Thigh Pain
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History of the Present Illness:
A 40 year-old woman, unrestrained
driver in a single-vehicle crash whose car struck a light pole
is brought to the emergency department (ED) complaining of bilateral
thigh pain. She denies losing consciousness but was amnestic
to the events of the accident. Paramedics report significant
damage to the front-end of her car as well as to the steering
column. She denies chest pain, shortness-of-breath, or abdominal
pain. She also complains of bleeding from several facial lacerations.
Her past medical history was only significant for an anxiety
disorder for which she takes alprazolam.
Physical examination:
The patient is alert but has
a strong odor of alcohol on her breath. Her vital signs are blood
pressure 100/50 torr, pulse 86 beats/min, respirations 18 breaths/min,
and temperature 97.0 F (oral). Her face has several 1.5 cm lacerations
to the right cheek near her nares as well as across her columella.
Her nasal bridge is unstable, but there is no septal hematoma.
Her neck is non-tender without palpable midline stepoffs. Chest
and abdominal examinations are normal. The patient is unable to
lie flat on the backboard. Her pelvis is somewhat twisted with
the left side of the pelvis held anterior to the right side.
Her right leg is externally rotated and flexed at the hip and
knee. Her left leg is internally rotated and extended at the
hip and knee (Figure 1). She has no swelling to her thighs or
focal tenderness to her legs except at the hips. She is unable
to actively move either hip joint because of severe pain. There
is a palpable fullness at the level of her right inguinal ligament.
She has a superficial laceration to the anterior aspect of her
right knee and several smaller abrasions to the lateral aspect
of her left knee. The rest of her lower extremities appear atraumatic.
Distal pulses are 2+ and symmetrical. Her neurovascular examination
is normal.
Laboratory:
Abnormal laboratory results include a
white blood count of 14,500 and serum ethanol level of 233 mg/dl.
Hemoglobin is 11.6 and hematocrit was 34.
Electrolytes, liver
function tests, creatinine, serum toxicities, and urine toxicities
are within normal limits.
A pregnancy test is negative and urinalysis
is normal.
Radiography and Hospital Course:
An AP pelvis radiograph
shows a right anterior hip dislocation and left posterior hip
dislocation (Figure 2). Post reduction radiographs (including
Judet views) are negative for fractures. Her remaining radiographic
evaluation is negative except for a nasal fracture.
The patient course, diagnosis and discussion
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