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Hip Reduction

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Other Names

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

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

Anatomy


Indications


Contraindications

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

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

Preparation

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[1]

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
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[2]
    • Allis Leg Extension Method
    • Reverse Bigelow Method
    • Lateral Traction Method
    • Stimson Gravity Method

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[3]
  • 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[4]

Complications


See Also


References

  1. Gottlieb, Michael. "Managing Posterior Hip Dislocations." Annals of Emergency Medicine (2022).
  2. Dawson-Amoah K, Raszewski J, Duplantier N, Waddell BS. Dislocation of the Hip: A Review of Types, Causes, and Treatment. Ochsner J. 2018;18(3):242–252. doi:10.31486/toj.17.0079
  3. Clegg, Travis E., et al. "Hip dislocations—epidemiology, treatment, and outcomes." Injury 41.4 (2010): 329-334.
  4. DeWal, Hargovind, et al. "Efficacy of abduction bracing in the management of total hip arthroplasty dislocation." The Journal of arthroplasty 19.6 (2004): 733-738.
Created by:
John Kiel on 26 September 2022 15:56:40
Authors:
Last edited:
26 September 2022 17:30:59
Category: