Initial Management and Treatment for Hip Dislocation
Hip dislocations are medical emergencies requiring prompt reduction to minimize the risk of avascular necrosis and should be treated with immediate closed reduction followed by appropriate post-reduction management. 1
Initial Assessment and Management
- Hip dislocations are painful injuries that require immobilization, adequate analgesia, and prompt diagnosis through clinical assessment and imaging 2
- Clinical signs include hip pain, inability to weight-bear, and a shortened, externally rotated leg on the affected side in posterior dislocations (the most common type) 2
- Radiographic confirmation with pelvic X-ray should be obtained but should not delay treatment in obvious cases 2
- CT scan should be performed after reduction to assess for associated fractures and ensure concentric reduction 2, 3
Reduction Techniques
Posterior Hip Dislocations (Most Common)
- Reduction is performed by applying longitudinal traction with internal rotation on the hip 1
- Success rates for most reduction techniques range from 60-90%, so familiarity with multiple techniques is important 4
- Adequate sedation and muscle relaxation are essential for successful closed reduction 3
Anterior Hip Dislocations
- Reduced by applying inline traction and external rotation, often with an assistant pushing on the femoral head or pulling the femur laterally 1
- These are less common but require the same urgency in treatment 1
Timing of Reduction
- Reduction should be performed within 12 hours of injury to minimize complications, particularly avascular necrosis of the femoral head 3
- Delay in reduction beyond 24 hours significantly worsens outcomes and increases complication rates 5
- Multiple attempts at closed reduction are contraindicated, particularly in complex cases with femoral head fractures 5
Post-Reduction Management
- Confirm concentric reduction with post-reduction radiographs of the pelvis 3, 5
- Any abnormality or failure to achieve concentric reduction requires immediate surgical intervention 5
- Post-reduction care should include appropriate pain management, antibiotic prophylaxis if surgical intervention was needed, and early mobilization as tolerated 2
Indications for Open Reduction
- Failed closed reduction after one or two attempts 3
- Unstable reduction when examined under anesthesia 6
- Presence of intra-articular fragments 5
- Associated femoral head or acetabular fractures that prevent concentric reduction 5
- Sciatic nerve injury requiring exploration 5
Complications and Follow-up
Major complications include avascular necrosis of the femoral head (reported in up to 10% of cases) and post-traumatic arthritis (up to 16%) 3
Risk factors for complications include:
Long-term follow-up is necessary, particularly in complex cases, as arthritic changes may develop in more than 50% of patients with associated femoral head fractures 5