Hip Dislocation and Reduction

imagesClinical suspicion of hip dislocation


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


imagesRadiographic evidence of hip dislocation


CONTRAINDICATIONS



imagesAssociated femoral neck fracture


imagesCoexistent fracture in dislocated extremity


RISKS/CONSENT ISSUES



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


   imagesMore common in the elderly with osteoporotic bones


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



imagesGeneral Basic Steps


   imagesObtain radiographs


   imagesSedation/Analgesia


   imagesHave assistants for help


   imagesPerform procedure


LANDMARKS



imagesPosterior Hip Dislocation


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


   imagesClinical 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)


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


imagesAnterior Hip Dislocation


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


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


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


TECHNIQUE



imagesPreprocedure


   imagesRadiographs


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



images


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.)



images


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.)


imagesPosterior Dislocation Reduction


   imagesAllis Maneuver (FIGURE 66.4)


      imagesPatient is placed supine


      imagesDownward stabilization of the pelvis is performed by an assistant


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


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


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


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



images


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.)

Only gold members can continue reading. Log In or Register to continue

Aug 9, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Hip Dislocation and Reduction
Premium Wordpress Themes by UFO Themes