HIP

REDUCTION

TECHNIQUE

DR. S. A. MEDWAY

1ST

JUNE 2017

THE PROBLEM

Congenital/Paed Dislocated Hips

Dislocated THRs

- Charlies Patients

- Perhaps 5% of Primary THR

- Up to 30% of Revision THR

- Beware Constrained Liner THR!

- Metal ring around acetabular component

- Need reduction in OT

Dislocated Native Hips

- High Energy Trauma

Dislocated Hip Resurfacing

- Call for Help

CONSIDERATIONS

- Primary survey

- Other injuries

- Make the diagnosis

- Diagnose any complications

- Procedural sedation

- Timing

MAKE THE DIAGNOSIS

Posterior Dislocation 90%

- Mechanism: FLEXION, ADDUCTION, INTERNAL ROTATION

- Xray: Small Femoral Head, Lesser Trochanter less prominent

- Usually from posterior approach operation (look for scar)

Anterior Dislocation

- Mechanism: EXTENSION, ABDUCTION, EXTERNAL ROTATION

- Xray: Large Femoral Head, Lesser Trochanter more prominent

- Usually from anterior approach operation (becoming more common)

GENERAL PRINCIPLES

Like ALL Dislocations

- Stop opposing forces

- Traction & Countertraction

- Restore the anatomy by re-opposing the joint surfaces

GET THE FORCES RIGHT

(POSTERIOR DISLOCATION)

TECHNIQUE 1

(THE BEST)

ALLIS TECHNIQUE

TECHNIQUE 1

(THE BEST)

ALLIS TECHNIQUE

(WADDELL VARIANT)

TECHNIQUE 1

(THE BEST)

ALLIS TECHNIQUE

Allis Video

https://www.youtube.com/watch?v=W89jgZbeBEc&t=141s

TECHNIQUE 2

CAPTAIN MORGAN

TECHNIQUE 2

CAPTAIN MORGAN

Captain Morgan Video

https://www.youtube.com/watch?v=HlMVx-ZWOQg

TECHNIQUE 3

WHISTLER

TECHNIQUE 3

WHISTLER

Whistler Video

https://www.youtube.com/watch?v=UxUhW4Zac74

TECHNIQUE 4

EAST BALTIMORE LIFT

TECHNIQUE 4

EAST BALTIMORE LIFT

East Baltimore Lift Video

https://www.youtube.com/watch?v=ZNP1luk1q-Q

TECHNIQUE 5

STIMPSON METHOD

TECHNIQUE 5

STIMPSON METHOD

Stimpson Example

TECHNIQUES FOR

ANTERIOR DISLOCATION

TECHNIQUES FOR

ANTERIOR DISLOCATION

POST REDUCTION

Examine

- Neurovascular status

- Joint movements

- Compare medial malleolar heights when leg straight

Image again

- Xray vs. CT Scan

Disposition

- CCT & Home vs. Ortho Ward Admit vs. Ortho Theatre

COMPLICATIONS

EARLY

- Sciatic Nerve Injury

- Femoral Nerve Injury

- Femoral Artery Injury

- Fractures

- Knee Injury

COMPLICATIONS

LATE

- Avascular Necrosis

- Osteoarthritis

- Instability / Recurrent Dislocation

- Complications of Immobilisation