injuries poisoning
Hip Dislocations
Treatment of Hip Dislocations
Closed reduction 6 hours; delay increases the risk of Osteonecrosis (ON) ( The hip can be reduced using one of the following techniques: Allis technique Captain Morgan technique Rocket launcher technique When any of these techniques is used, the patient requires sedation and muscle relaxation and is in the supine position. (See also How To Reduce a Posterior Hip Dislocation .) For theAllis technique,the hip is gently flexed to 90°, and vertical traction is applied to the femur; this maneuver may be easiest and safest when the patient is temporarily placed on a rigid backboard that is put on the floor. A strap or brace is used to hold down the patient's hips (providing counterpressure to the vertical traction of the femur). Captain Morgan technique , ( Treatment references ), the practitioner stands on the side of the affected hip and faces the patient's feet. The dislocated hip and knee are flexed to 90°. The patient's hips are held down by a sheet or by a second practitioner (to provide countertraction to the pelvis). The practitioner squats, and the patient's knee is placed on the practitioner's shoulder; the practitioner essentially holds the leg like a rocket launcher. The patient's hip is adducted by pressing inward on the knee and is internally rotated by turning the foot out; the practitioner then gently applies traction to the femur by standing from the squat and pulling down on the patient's foot, using the practitioner's shoulder as a fulcrum. After reduction, CT is needed in all native hips to identify acetabular and femoral head fractures and intra-articular debris or loose bodies (bone or cartilage fragments). About 70% of patients with posterior dislocation of the hip have a concomitant acetabular fracture ( Treatment references ). If fractures or loose bodies are found, an orthopedist should be consulted about possible surgical intervention. If CT does not show any fractures or loose bodies, patients are sent home with crutches and told that their foot may touch the floor (eg, to maintain balance) but they should not put any weight on it (toe-touch weight bearing), at least until they are given permission to do so after orthopedic follow-up. 1.Kellam P, Ostrum RF: Systematic review and meta-analysis of avascular necrosis and posttraumatic arthritis after traumatic hip dislocation.J Orthop Trauma30 (1):10–16, 2016. doi: 10.1097/BOT.0000000000000419 2.Hendey GW, Avila A: The Captain Morgan technique for the reduction of the dislocated hip.Ann Emerg Med58 (6):536–540, 2011. doi: 10.1016/j.annemergmed.2011.07.010 3.Dan M, Phillips A, Simonian M, et al: Rocket launcher: A novel reduction technique for posterior hip dislocations and review of current literature.Emerg Med Australas27 (3):192–195, 2015. doi: 10.1111/1742-6723.12392 4.Hak DJ, Goulet JA: Severity of injuries associated with traumatic hip dislocation as a result of motor vehicle collisions.J Trauma47(1):60–63, 1999. doi: 10.1097/00005373-199907000-00014 