Immediate Reduction of Hip Dislocations is Essential
A dislocated hip requires immediate reduction to minimize complications such as avascular necrosis, posttraumatic arthritis, and sciatic nerve injury. The timing of reduction is critical, with evidence supporting reduction within 6 hours of injury to achieve the best outcomes 1.
Why Immediate Reduction is Critical
Hip dislocations are high-energy injuries that disrupt the blood supply to the femoral head. The longer the hip remains dislocated:
- Higher risk of avascular necrosis of the femoral head
- Increased likelihood of sciatic nerve damage
- Greater potential for long-term degenerative changes
- Poorer functional outcomes
Types of Hip Dislocations
Hip dislocations are classified according to the direction of displacement:
- Posterior dislocations (most common): Femoral head is displaced posteriorly
- Anterior dislocations: Femoral head is displaced anteriorly
- Inferior dislocations: Rarest type, femoral head is displaced inferiorly 1
Reduction Approach
Initial Assessment
- Assess for associated injuries (common with high-energy trauma)
- Obtain pre-reduction radiographs if the patient is stable
- Check neurovascular status, particularly sciatic nerve function
Reduction Techniques
- Posterior dislocations: Apply longitudinal traction with internal rotation 2
- Anterior dislocations: Use inline traction with external rotation, often with an assistant pushing on the femoral head 2
- Inferior dislocations: Typically managed with closed reduction under anesthesia 1
Setting
- Emergency department is the typical setting for reduction
- On-field reduction has been performed successfully in limited cases for athletes 3
- General anesthesia or procedural sedation is usually required
Post-Reduction Management
After successful reduction:
- Obtain post-reduction radiographs and CT scan to confirm concentric reduction and identify any associated fractures 4
- Assess stability of the reduction
- Implement early mobilization protocols to prevent complications
Complications of Delayed Reduction
Delaying reduction beyond 6 hours significantly increases the risk of:
- Avascular necrosis (rates as high as 15-30%) 5
- Posttraumatic arthritis
- Sciatic nerve injury with potential permanent deficit
- Need for surgical intervention
Special Considerations
- Simple vs. Complex Dislocations: Simple dislocations (without fractures) have better outcomes than complex fracture-dislocations 4
- Surgical Management: Indicated for non-concentric reductions, associated fractures, or persistent instability 4
- Follow-up: Close monitoring is essential to detect early complications 1
Hip dislocations represent true orthopedic emergencies. The evidence strongly supports immediate reduction to restore blood flow to the femoral head and minimize long-term complications. While the specific reduction technique may vary based on the type of dislocation, the principle of urgent intervention remains paramount for preserving hip function and preventing devastating complications.