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Hip Dislocations

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Most hip dislocations are posterior and result from severe posteriorly directed force to the knee while the knee and hip are flexed (eg, against a car dashboard).

Complications may include

  • Sciatic nerve injury

  • Delayed osteonecrosis of the femoral head

Associated injuries include

  • Patella fractures

  • Posterior cruciate ligament injuries

  • Acetabular and femoral head fractures

In patients with posterior dislocations, the leg is shortened, adducted, and internally rotated. Anterior dislocations are rare and result in the leg being abducted and externally rotated.

Diagnosis

  • X-rays

Routine hip x-rays are diagnostic.

Treatment

  • Closed reduction

Treatment is closed reduction as soon as possible, preferably in ≤ 6 h; delay increases the risk of osteonecrosis.

The hip can be reduced using one of the following techniques:

  • Allis technique

  • Captain Morgan technique

When either technique is done, the patient requires sedation and muscle relaxation and is in the supine position.

For the Allis 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.

For the Captain Morgan technique, the patient's hips are held down by a sheet or belt, and the dislocated hip is flexed. Practitioners then place their knee under the patient's knee and lift up while applying vertical traction to the femur (see Figure: Captain Morgan technique..).

Captain Morgan technique.

After reduction, CT is usually done to identify fractures and intra-articular debris.

Dislocated prosthetic hip

After total hip replacement, the prosthetic hip dislocates in up to 2% of patients. Posterior dislocations are more common.

Closed reduction is often successful, particularly for first-time dislocations, but hip revision surgery is sometimes required.

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* This is the Professional Version. *