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Dislocation Reduction of the Hip Joint

  • Editor(s): Todd W Thomsen, MD, Gary S Setnik, MD, FACEP
  • Section Editor(s): Phillip M Harter, MD
  • Contributor(s): Carmie Chan, MD
PRE-PROCEDURE
INDICATIONS
  • Native hip dislocations: posterior or anterior
  • Prosthetic hip dislocations
CONTRAINDICATIONS
  • There are no absolute contraindications to closed reduction of hip dislocations.
  • Lifesaving procedures must be performed first.
  • Associated fractures may require surgical reduction.
EQUIPMENT

No specific equipment is required for closed reduction of the hip.
ANATOMY
  • The diagnosis is based on the position of the femoral head and the acetabulum.
  • The medial and lateral circumflex femoral arteries supply the femoral head.
  • The sciatic nerve is posterior to the hip and can be injured in posterior dislocations.
  • The femoral artery and nerve can be damaged in anterior dislocations.
  • Posterior hip dislocations are by far the most common.
  • The femoral head comes to lie posterior to the acetabulum and assumes a semi-flexed, internally rotated position.
  • In anterior hip dislocations, the femoral head is displaced anterior to the acetabulum.
  • The femoral head may be seen lying over the obturator foramen.
Posterior hip dislocation.
Figure 2 :  Posterior hip dislocation.

Bony anatomy.
Figure 5 :  Bony anatomy.


PROCEDURE
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With the leg held in adduction, 1: Downward pressure on pelvis, 2: Axial traction to the femur, and 3: Internal and external rotation of the hip.
Figure 9 :  With the leg held in adduction, 1: Downward pressure on pelvis, 2: Axial traction to the femur, and 3: Internal and external rotation of the hip.

With your elbow under the ipsilateral knee, 1: Downward pressure on the pelvis, 2: Ankle immobilized on the stretcher, and 3: Upward elevation of the knee.
Figure 11 :  With your elbow under the ipsilateral knee, 1: Downward pressure on the pelvis, 2: Ankle immobilized on the stretcher, and 3: Upward elevation of the knee.

With the leg held in abduction, exert 1: downward pressure on pelvis, 2: axial traction to the femur, and 3: internal and external rotation of the hip.
Figure 12 :  With the leg held in abduction, exert 1: downward pressure on pelvis, 2: axial traction to the femur, and 3: internal and external rotation of the hip.


POST-PROCEDURE
CARE
  • Reexamine the hip range of motion to assess stability.
  • Repeat the neurovascular examination.
  • Immobilization
  • For posterior dislocations, use a simple knee immobilizer.
  • For anterior dislocations, an abduction pillow may be helpful.
  • If the hip remains unstable, a traction pin should be placed.
  • Obtain imaging studies immediately after reduction.
  • Arrange for definitive care and rehabilitation.
  • Precautions after posterior dislocation: avoid flexion of the hips past 45 degrees with internal rotation.
  • Precautions after anterior dislocation: avoid hyperextension of the hip with external rotation.
COMPLICATIONS
  • Re-examine the hip range of motion to assess stability.
  • Repeat the neurovascular examination.
  • Immobilization
  • For posterior hip dislocations, a simple knee immobilizer.
  • For anterior hip dislocations, an abduction pillow may be helpful.
  • If the hip remains unstable, consult orthopedic surgery.
  • Obtain imaging studies immediately after reduction.
  • Arrange for definitive care and rehabilitation.
  • Posterior precautions: avoid flexion of the hips past 45° with internal rotation.
  • Anterior precautions: avoid hyperextension of the hip with external rotation.
Assess range of motion after reduction.
Figure 13 :  Assess range of motion after reduction.

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