Hip Dislocation Management

1. By Kenneth Lo
aka Dr Kate Ferguson
05/12/13

2. • Hip is a modified ball and socket joint.
• Femoral head is deep in the acetabular socket
– enhanced by the cartilaginous labrum.
• Supported by fibrous joint capsule,
ischiofemoral ligament, muscles of upper thigh
and gluteal region.
• Large amount of force needed to dislocated
the joint – hence concurrent injuries

4. • Simple vs complex
• Complex associated with fractures.
• 3 main patterns in relation to
acetabulum:- posterior, anterior, central.

5. Posterior dislocation
• Mostly posterior dislocation (80-90% of dislocations in
MVA)
• Force via a flexed hip – knee striking the dashboard
and transmits force through femur and hip.

6. • Posterior: - flexed, internally rotated, and
adducted.

7. Anterior Dislocation
• Femoral head situated anterior to
acetabulum
• Hyperextension force against an abducted
leg that levers head out of acetabulum.
• Also force against posterior femoral head
or neck can produce dislocation

8. • Anterior: The hip is minimally flexed,
externally rotated and markedly abducted

9. Central dislocation
• ALWAYS fracture dislocation
• Lateral force against an adducted femur –
side impact MVA.

10. Neurovascular examination
• Signs of sciatic nerve injury include the
following:
– Loss of sensation in posterior leg and foot
– Loss of dorsiflexion (peroneal branch) or
plantar flexion (tibial branch)
– Loss of deep tendon reflexes at the ankle S1,2
• Signs of femoral nerve injury include the
following:
– Loss of sensation over the thigh
– Weakness of the quadriceps
– Loss of deep tendon reflexes at knee L3, 4

14. 1:Femoral
(L2, L3, L4)
2:Obturator
(L2, L3)
3: Common
Fibular

15. Treatment
•
•
•
•
•
Whistler technique
Stimson method
Allis method
Captain Morgan technique
East Baltimore lift

16. Whistler’s technique
• The patient lies supine on the gurney.
• Unaffected leg is flexed with an assistant stabilizing the
leg. The assistant can also help stabilize the pelvis.
• Provider's forearm is placed under the affected leg in the
popliteal fossa then grasps the knee of the unaffected
leg.
• Provider's other hand grasps the lower leg of the
affected leg, usually around the ankle.
• The dislocated hip should be flexed to 90 degrees.
• The provider's forearm is the fulcrum and the affected
lower leg is the lever.
• When pulling down on the lower leg, it flexes the knee
thus pulling traction along the femur.
• You can also add some internal/external rotation to
facilitate the reduction

18. • described primarily for acute posterior dislocations, but
anterior dislocations can occasionally be reduced by
this method
• believed to be least traumatic
• pt is in prone position w/ lower limbs hanging from end
of table
• assistant immobilizes the pelvis by applying pressure
on the sacrum
• hold knee and ankle flexed to 90 deg & apply
downward pressure to leg just distal to the knee
• gentle rotatory motion of the limb may assist in
reduction

20. • Indications for open reduction
– Irreducible dislocation (approximately 10% of
all dislocations)
– Persistent instability of the joint following
reduction (eg, fracture-dislocation of the
posterior acetabulum)
– Fracture of the femoral head or shaft
– Neurovascular deficits that occur after closed
reduction

21. Post reduction
• After reduction, patients with hip dislocation
should be admitted to the hospital. Patients will be
non-ambulatory and require a great deal of
supportive care. Pain will be significant, even after
reduction, and patients may require parenteral
narcotics.
• The duration of traction and non–weight-bearing
immobilization is controversial. Evidence suggests
that early weight bearing (eg, 2 wk after
relocation) may increase the severity of aseptic
necrosis when it occurs.
• Early weight bearing decreases the incidence of
other complications (eg, venous
thromboembolism, decubiti),

22. • Fracture-dislocations or concomitant fractures of the
femoral neck usually require the expertise of an
orthopaedic specialist.
• If relocation of the hip is successful, immobilize the
legs in slight abduction by using a pad between the
legs to prevent adduction until skeletal traction can
be instituted.
• After reduction, patients with hip dislocation should
be admitted to the hospital.
• The duration of traction and non–weight-bearing
immobilization is controversial. Evidence suggests
that early weight bearing (eg, 2 wk after relocation)
may increase the severity of aseptic necrosis when
it occurs.
• Early weight bearing decreases the incidence of
other complications (eg, venous thromboembolism,
decubiti), and some studies have found equivalent
outcomes with early and delayed weight bearing.

23. Complications
• Early:
–
–
–
–
Sciatic nerve injury (posterior dislocation)
Femoral-nerve injury
Fractures of head and neck
Femoral-artery injury (in anterior dislocations)
• Late:
–
–
–
–
–
–
AVN of the hip incidence of AVN increases with multiple attempts.
Osteoarthritis
Heterotopic calcification
Recurrent dislocation
Ligamentous injury of the knee, other fractures
Complications of immobilization (DVT, pulmonary embolus, decubiti,
pneumonia)