Hip Reduction

Other Names

• Posterior Hip Dislocation Reduction
• Hip Dislocation Reduction
• Anterior Hip Dislocation
• Lateral Hip Dislocation

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Background

• This page describes techniques to reduce dislocation of the Hip Joint
  • Due to significant gluteal muscle antagonism, it is recommended reduction be performed with procedural sedation

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Indications

• Hip Dislocation
  • Note the vast majority are posterior

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Contraindications

• Absolute
  • None
• Relative
  • Concomitant hip, pelvis or lower extremity fractures may make closed reduction impossible

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Procedure

Equipment

• Examination table or patient bed
• Most techniques require 2 physicians
• Spine board can be helpful
• Procedural Sedation
  • Require all the appropriate medications and monitoring

Posterior Dislocation

Reduction Technique	Advantages	Disadvantages
Modified Allis	-Reduced risk of injury compared with the traditional Allis technique -Greater force generated using the stronger leg muscles	-Patient positioning can be challenging
Piggyback/Rocket Launcher	-Greater force generated using the stronger leg muscles -Enhanced control of patient hip position	-Patient positioning can be challenging
East Baltimore Lift	-Generates the most force using the stronger leg muscles of 2 clinicians	-Requires more people
Tulsa/Rochester/Whistler	-Can be performed by a single clinician	-Risk of injury to the clinician’s arm if not careful -May not get sufficient force as some of the other techniques -Contraindicated in patients with contralateral lower extremity fractures or dislocations
Captain Morgan	-Backboard stabilizes patient and provides better countertraction than a patient bed	-May be difficult for clinicians with shorter legs to gain sufficient leverage -May not get as sufficient force as some of the other techniques
Stimson/Modified Stimson	-More ergonomic -Uses gravity to supplement the force needed	-Can be difficult to position the patient and needs multiple assistants so the patient does not fall off the bed -Less ideal for procedural sedation -More challenging in patients with larger abdominal girth -Contraindicated in patients with cervical spine injury

^ Table and images

Modified Allis (Image #1)

Piggyback and Rocket Launcher (Image #2)

• Modified Allis (Image #1)
  • Traditional: physician standing, grasping the patient’s leg with the patient’s knee and hip flexed at 90°
  • Physician then applies axial traction while an assistant holds the patient on the bed
  • Concern: technique places both the patient and physician at risk of injury, including back strain and falling
  • Modification: physician stands on the side of the bed, elevates the patient’s leg by placing it on their shoulder and slowly standing up
  • This utilizes the stronger leg muscles
  • If the hip is significantly adducted or rotated, may need to rotate the patient 20°-30° on the bed
  • This allows sufficient room to get beneath the patient’s leg.
• Piggyback/Rocket Launcher (Image #2)
  • Similar to Allis, allows greater control of the hip position.
  • The patient is supine at the end of the bed, hip and knee flexed at 90°
  • Physician places the patient’s knee over their shoulder, slowly leans forward and stands up while guiding the thigh into adduction.
  • Rocket launcher technique: modification wherein the physician begins by adducting and internally rotating the hip to exaggerate the deformity before standing up
  • Study: successful reduction in 5 out of 6 cases in the original description
• East Baltimore Lift (Image #3)
  • Patient lies supine on the bed, 2 physicians on each side of the patient
  • Hip and knee flexed at approximately 90°, physicians lock arms underneath the patient’s knee, while stabilizing the knee at the ankle joint
  • Ned should be sufficiently low such that both clinicians’ backs are straight and their knees are bent at approximately 45°
  • Use a third person or sheet should stabilize the patient’s pelvis
  • Both physicians then stand up slowly, applying axial traction to the femur while gently internally and externally rotating the hip via the ankle

• 
  East Baltimore Lift (Image #3)
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  Tulsa/Rochester/Whistler (Image #4)
• 
  Captain Morgan (Image #5)

Stimson (Image #6)

Modified Stimson (Image #7)

• Tulsa/Rochester/Whistler (Image #4)
  • Variation of the East Baltimore lift
  • Patient flexes both hips and knees on the bed
  • Physician places their arm underneath the knee on the affected side, palm on the contralateral knee
  • Bed should be sufficiently low such that the physicians back is straight, their knees are bent at approximately 45°
  • Physician slowly stands up, using their arm to provide axial traction on the hip, while their other arm gently internally and externally rotates the leg.
  • Study: 73.3% success rate (compared with 62.5% for the Allis or modified Allis technique)

• Captain Morgan (Image #5)
  • Patient supone on backboard, hip and knee flexed at 90°
  • Physician places hand under the patient’s knee, their knee under the proximal aspect of the patient’s lower leg
  • Use contralateral hand to stabilize the patient’s knee in flexion
  • Physician then plantarflexes at their ankle while using their arm to lift upward, applying axial traction at the patient’s hip
  • Pitfall: avoid pushing down on the patient’s ankle, as this may cause ligamentous injury to the patient’s knee
  • Study: 92% success rate among 13 cases
• Stimson/Modified Stimson (Image #6, #7)
  • Patient is prone, affected leg flexed to 90°, hanging off the end of the bed
  • Patient’s hip and knee are flexed to 90°
  • Physician applies a downward force to the lower leg with one arm while internally and externally rotating the patient’s hip with their other hand
  • Modification: physician places their knee on the proximal calf near the popliteal, and slowly transfers their weight to the bent knee
• Not Reviewed (Need to be added)
  • Bigelow Maneuver
  • Lefkowitz Maneuver
  • Howard Maneuver
  • Lateral Traction Method
  • Skoff Maneuver

Anterior Dislocation

• Closed Reduction Maneuvers for Anterior Hip Dislocations
  • Allis Leg Extension Method
  • Reverse Bigelow Method
  • Lateral Traction Method
  • Stimson Gravity Method

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Aftercare

• General
  • Strict immobilization is not recommended
  • Early active and passive range of motion exercises with either no weight-bearing or toe-touch weight-bearing (5-10 pounds) for the first several weeks
• Restrictions
  • Avoid flexing hip beyond 90°
  • Avoid any twisting motions
  • Avoid crossing their leg past midline
• Abduction Brace
  • While commonly used, abduction braces remain controversial
  • Have not been demonstrated to reduce the risk of recurrent dislocations in patients with prosthetic hips

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Complications

• See: Hip Dislocation Complications

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See Also

• Hip Pain Main
• Procedures Main

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