HIP REDUCTION TECHNIQUE DR. S. A. MEDWAY 1 ST JUNE 2017
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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
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