- performed as soon a possible ( < 8-12 hrs)
- either in OR under GEA (optimal) or in ER w/ sedation if delays are expected;
- reduction may be performed w/ flouro, but orthopaedist may find that flouro interferes w/ hip flexion, which frequently is essential to performing an atraumatic reduction;
- frequently all that is needed is one assistant to apply pressure to the ASIS, as the surgeon flexes the hip while applying traction;
- reduction is felt as gentle clunk, at which point x-rays are obtained;
- Radiographic Evaluation
- Methods of Reduction:
- Rochester Method:
- patient is placed supine with uninjured hip and knee flexed (this knee acts as a pivot point for the surgeon's hand);
- one of the surgeon's hands is place underneath the injured knee and over top of the uninjured knee;
- this manuever flexes both the patient's injured hip and knee;
- the other hand grab's the ankle (injured side) and this can be used to generate traction (by pressing down on ankle) and at the same time the ankle can be used to control hip rotation;
- reduction is obtained by traction, internal rotation, and then external rotation once the femoral hip clears the acetabular rim;
- other reduction methods include:
- Gravity Method of Stimson
- Allis's maneuver
- Bigelow's Maneuver
- Post Reduction Management:
- any widening of the join space after reduction suggests possibility of loose fragments or soft tissue in joint;
- this requires open reduction & removal of osteochondral fragments (see hip arthroscopy);
- always get post reduction CT scan:
- if reduction is concentric but unstable and there are no assoc frx, traction should be maintained for 4-6 wks until soft-tissue healing occurs
Reduction of posterior dislocation of the hip in the prone position.
The East Baltimore Lift: a simple and effective method for reduction of posterior hip dislocation.
Posterior Hip Dislocation, a New Technique for Reduction.
A Flexion Adduction Method for the Reduction of Posterior Dislocatioon of the Hip.