Hip Dislocation and Reduction

Clinical suspicion of hip dislocation

Hip pain with obvious deformity in the setting of a motor vehicle crash, pedestrian struck by a vehicle, falls, or sports-related injuries

Radiographic evidence of hip dislocation

CONTRAINDICATIONS

Associated femoral neck fracture

Coexistent fracture in dislocated extremity

RISKS/CONSENT ISSUES

Inadvertently converting a dislocation to a fracture-dislocation (acetabulum or femoral head fracture)

More common in the elderly with osteoporotic bones

Oversedation may lead to inability to protect the airway with subsequent potential risk of aspiration

General Basic Steps

Obtain radiographs

Sedation/Analgesia

Have assistants for help

Perform procedure

LANDMARKS

Posterior Hip Dislocation

Mechanism of injury—femoral head is forced out of the acetabulum and rests posteriorly

Clinical features—affected extremity shortened, adducted, and internally rotated; patient may hold hip flexed with knee of affected extremity resting on opposite knee (FIGURE 66.1)

Radiographic evidence—femoral head resting posterior to the acetabulum (FIGURE 66.2)

Anterior Hip Dislocation

Mechanism—forced abduction with the hip in a flexed position or forced hyperextension of the hip

Clinical features—affected extremity abducted, slight flexion, and externally rotated

Radiographic evidence—femoral head dislocated medially toward obturator foramen (obturator dislocation) and femoral head dislocated laterally toward pubis (pubic dislocation) (FIGURE 66.3)

TECHNIQUE

Preprocedure

Radiographs

Should be obtained preprocedure only if there is a concern for a fracture or to determine the position of the dislocation

FIGURE 66.1 Normal (left) and dislocated (right) hip. (From Young GM. Reduction of common joint dislocations and subluxations. In: Henretig FM, King C, eds. Textbook of Pediatric Emergency Procedures. Philadelphia, PA: Williams & Wilkins; 1997:1093, with permission.)

FIGURE 66.2 Anteroposterior pelvis radiograph of a posterior hip dislocation of the right hip. (From Tornetta Paul III. Hip dislocations and fractures of the femoral head. In: Bucholz RW, Heckman JD, Court-Brown C, eds. Rockwood and Green’s Fractures in Adults. Vol 2. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:1718, with permission.)

Posterior Dislocation Reduction

Allis Maneuver (FIGURE 66.4)

Patient is placed supine

Downward stabilization of the pelvis is performed by an assistant

With the knee flexed, apply traction in-line with the deformity with gentle flexion of the hip to 90 degrees

Perform gentle internal-to-external rotation as the hip is flexed

Once reduction is achieved, hip is brought to the extended position while traction is maintained

Legs are then immobilized in slight abduction through the placement of pillows between the knees

FIGURE 66.3 Anteroposterior pelvis radiograph of an anterior hip dislocation of the left hip. (From Tornetta Paul III. Hip dislocations and fractures of the femoral head. In: Bucholz RW, Heckman JD, Court-Brown C, eds. Rockwood and Green’s Fractures in Adults. Vol 2. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:1720, with permission.)

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