Hip dislocation - Revision history

Rossdonaldson1 at 20:25, 26 February 2025

2025-02-26T20:25:34Z

← Older revision		Revision as of 20:25, 26 February 2025
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	==Background==		==Background==
	~~[[File:Slide2DAD.jpg\|thumb\|~~Hip anatomy~~.]]~~		{{Hip anatomy background images}}
	*Orthopedic emergency		*Orthopedic emergency
	**Reduction of native hip should occur within 6hr due to high risk of avascular necrosis		**Reduction of native hip should occur within 6hr due to high risk of avascular necrosis

Rossdonaldson1: /* Video */

2024-04-17T20:16:43Z

Video

← Older revision		Revision as of 20:16, 17 April 2024
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	*Recurrent dislocations: <2%		*Recurrent dislocations: <2%

	==~~Video~~==		==External Links==
	~~{{#widget:YouTube\|id=BLZXlVnqLs0}}~~

	==References==		==References==

Rossdonaldson1: /* Background */

2021-05-13T18:44:47Z

Background

← Older revision		Revision as of 18:44, 13 May 2021
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	==Background==		==Background==
			[[File:Slide2DAD.jpg\|thumb\|Hip anatomy.]]
	*Orthopedic emergency		*Orthopedic emergency
	**Reduction of native hip should occur within 6hr due to high risk of avascular necrosis		**Reduction of native hip should occur within 6hr due to high risk of avascular necrosis

Rossdonaldson1: /* Allis Maneuver */

2021-05-13T17:20:41Z

Allis Maneuver

← Older revision		Revision as of 17:20, 13 May 2021
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	====Allis Maneuver====		====Allis Maneuver====
	[[File:Hip_Reduction.jpg\|thumb\|Allis maneuver.]]		[[File:Hip_Reduction.jpg\|thumb\|Allis maneuver.]]
	*~~supine~~ patient on table: deeper sedation (propofol helps with tissue relaxation); firm distal traction at flexed knee to pull head back into acetabulum; assistant stabilizes pelvis by pushing on ASISs		*Supine patient on table: deeper sedation ([[propofol]] helps with tissue relaxation); firm distal traction at flexed knee to pull head back into acetabulum; assistant stabilizes pelvis by pushing on ASISs

	====Captain Morgan Hip Reduction<ref>Hendey GW and Avila AA. The Captain Morgan Technique for the Reduction of the Dislocated Hip. Annals of Emergency Medicine, Volume 60, Issue 1, July 2012, Pages 135-136.</ref>====		====Captain Morgan Hip Reduction<ref>Hendey GW and Avila AA. The Captain Morgan Technique for the Reduction of the Dislocated Hip. Annals of Emergency Medicine, Volume 60, Issue 1, July 2012, Pages 135-136.</ref>====

Rossdonaldson1: /* Management */

2021-05-13T17:19:56Z

Management

← Older revision		Revision as of 17:19, 13 May 2021
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	*'''Femoral neck fracture is a contraindication to closed reduction'''		*'''Femoral neck fracture is a contraindication to closed reduction'''
	*[[Procedural sedation]]		*[[Procedural sedation]]

	===Posterior===		===Posterior===
	====Allis Maneuver====		====Allis Maneuver====
			[[File:Hip_Reduction.jpg\|thumb\|Allis maneuver.]]
	*supine patient on table: deeper sedation (propofol helps with tissue relaxation); firm distal traction at flexed knee to pull head back into acetabulum; assistant stabilizes pelvis by pushing on ASISs		*supine patient on table: deeper sedation (propofol helps with tissue relaxation); firm distal traction at flexed knee to pull head back into acetabulum; assistant stabilizes pelvis by pushing on ASISs
	~~[[File:Hip_Reduction.jpg\|250px]]~~
	====Captain Morgan Hip Reduction<ref>Hendey GW and Avila AA. The Captain Morgan Technique for the Reduction of the Dislocated Hip. Annals of Emergency Medicine, Volume 60, Issue 1, July 2012, Pages 135-136.</ref>====		====Captain Morgan Hip Reduction<ref>Hendey GW and Avila AA. The Captain Morgan Technique for the Reduction of the Dislocated Hip. Annals of Emergency Medicine, Volume 60, Issue 1, July 2012, Pages 135-136.</ref>====
	*See figure [http://67.media.tumblr.com/tumblr_lriey37Dpa1qafl51o1_500.png here]		*See figure [http://67.media.tumblr.com/tumblr_lriey37Dpa1qafl51o1_500.png here]
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	*Poses less risk of knee injury since most force is applied by lifting leg rather than applying leverage at knee		*Poses less risk of knee injury since most force is applied by lifting leg rather than applying leverage at knee
	*Less risk to provider who does not have to stand on top of gurney, and requires only one provider		*Less risk to provider who does not have to stand on top of gurney, and requires only one provider

	====The Waddell Technique<ref>Waddell BS, Mohamed S, Glomset JT, Meyer MS. A Detailed Review of Hip Reduction Maneuvers: A Focus on Physician Safety and Introduction of the Waddell Technique. Orthop Rev (Pavia). 2016;8(1):6253.</ref>====		====The Waddell Technique<ref>Waddell BS, Mohamed S, Glomset JT, Meyer MS. A Detailed Review of Hip Reduction Maneuvers: A Focus on Physician Safety and Introduction of the Waddell Technique. Orthop Rev (Pavia). 2016;8(1):6253.</ref>====
			[[File:Waddell_Technique.jpg\|thumb\|The Waddell technique]]
	*A modified Allis Maneuver that allows the provider to follow back safety recommendations provided by OSHA		*A modified Allis Maneuver that allows the provider to follow back safety recommendations provided by OSHA
	*Provider hovers over patient on the bed and places their forearm under the patient's knee		*Provider hovers over patient on the bed and places their forearm under the patient's knee
	*The provider squats down, draping their forearm over their knees with the elbow on one knee and wrist/hand over the other knee		*The provider squats down, draping their forearm over their knees with the elbow on one knee and wrist/hand over the other knee
	*Provider then leans back, pivoting on feet and holding the patient's leg close to their chest, while an assistant stabilizes the pelvis		*Provider then leans back, pivoting on feet and holding the patient's leg close to their chest, while an assistant stabilizes the pelvis
	~~[[File:Waddell_Technique.jpg\|250px]]~~

	===Anterior===		===Anterior===

Rossdonaldson1: /* Evaluation */

2019-06-25T17:17:53Z

Evaluation

← Older revision		Revision as of 17:17, 25 June 2019
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	==Evaluation==		==Evaluation==
			===Workup===
	[[File:HipdisX.png\|thumb]]		[[File:HipdisX.png\|thumb]]
	[[File:Posthipdislocation.jpg\|thumb\|Post-surgical hip dislocation]]		[[File:Posthipdislocation.jpg\|thumb\|Post-surgical hip dislocation]]
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	*Consider knee xray		*Consider knee xray
	*Consider CT to evaluate acetabulum for subtle fractures (esp for posterior dislocation)		*Consider CT to evaluate acetabulum for subtle fractures (esp for posterior dislocation)

			===Diagnosis===
			*Diagnosed typically via radiograph (see above)

	==Management==		==Management==

Rossdonaldson1: /* Clinical Features */

2019-06-25T17:16:43Z

Clinical Features

← Older revision		Revision as of 17:16, 25 June 2019
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	==Clinical Features==		==Clinical Features==
	*Posterior Dislocation		===Posterior Dislocation===
	**Extremity is shortened, internally rotated, adducted		*Extremity is shortened, internally rotated, adducted
	**Neurovascular exam may review sciatic nerve compromise		*Neurovascular exam may review sciatic nerve compromise
	*Anterior Dislocation
	**Extremity is extended (superior) or flexed (inferior), externally rotated, abducted<ref>Alonso JE, et al. A review of the treatment of hip dislocations associated with acetabular fractures. Clin Orthop Relat Res. 2000; 377(8):32-43.</ref>		===Anterior Dislocation===
			*Extremity is extended (superior) or flexed (inferior), externally rotated, abducted<ref>Alonso JE, et al. A review of the treatment of hip dislocations associated with acetabular fractures. Clin Orthop Relat Res. 2000; 377(8):32-43.</ref>

	==Differential Diagnosis==		==Differential Diagnosis==

Kearny89: /* Management */

2019-06-13T22:00:05Z

Management

← Older revision		Revision as of 22:00, 13 June 2019
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	==Management==		==Management==
	*Reduction recommended within 6 hours to prevent avascular necrosis of the femoral head<ref>Jaskulka RA, et al. Dislocation and fracture-dislocation of the hip. J Bone Joint Surg Br. 1991; 73(3):465-469.</ref>		*Reduction recommended within 6 hours to prevent avascular necrosis of the femoral head<ref>Jaskulka RA, et al. Dislocation and fracture-dislocation of the hip. J Bone Joint Surg Br. 1991; 73(3):465-469.</ref>
			*'''Femoral neck fracture is a contraindication to closed reduction'''
	*[[Procedural sedation]]		*[[Procedural sedation]]
	===Posterior===		===Posterior===

Kearny89: /* Complications */

2019-06-10T00:47:26Z

Complications

← Older revision		Revision as of 00:47, 10 June 2019
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	**5-40%		**5-40%
	**Delay in reduction >6 hours increases risk		**Delay in reduction >6 hours increases risk
	*Sciatic nerve injury		*Sciatic nerve injury (check EHL function - toe extension)
	**8-20% incidence		**8-20% incidence
	**Delay in reduction increases risk		**Delay in reduction increases risk

Kearny89: /* Posterior */

2019-06-05T00:05:17Z

Posterior

← Older revision		Revision as of 00:05, 5 June 2019
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	*[[Procedural sedation]]		*[[Procedural sedation]]
	===Posterior===		===Posterior===
	*Allis Maneuver: supine patient on table: deeper sedation (propofol helps with tissue relaxation); firm distal traction at flexed knee to pull head back into acetabulum; assistant stabilizes pelvis by pushing on ASISs		====Allis Maneuver====
			*supine patient on table: deeper sedation (propofol helps with tissue relaxation); firm distal traction at flexed knee to pull head back into acetabulum; assistant stabilizes pelvis by pushing on ASISs
	[[File:Hip_Reduction.jpg\|250px]]		[[File:Hip_Reduction.jpg\|250px]]
	====Captain Morgan Hip Reduction<ref>Hendey GW and Avila AA. The Captain Morgan Technique for the Reduction of the Dislocated Hip. Annals of Emergency Medicine, Volume 60, Issue 1, July 2012, Pages 135-136.</ref>====		====Captain Morgan Hip Reduction<ref>Hendey GW and Avila AA. The Captain Morgan Technique for the Reduction of the Dislocated Hip. Annals of Emergency Medicine, Volume 60, Issue 1, July 2012, Pages 135-136.</ref>====