methods of Hip Relocation

Question 1

Closed reduction

Answer 1

• perform with patient supine and apply traction in line with deformity regardless of direction of dislocation
• must have adequate sedation and muscular relaxation to perform reduction
• assess hip stability after reduction
• post reduction CT scan required to rule out
  
  • femoral head fractures
  • intra-articular loose bodies/incarcerated fragments
    
    • may be present even with concentric reduction on plain films
    • acetabular fractures
• post-reduction
  
  • for simple dislocation, follow with protected weight bearing for 4-6 weeks

Question 2

Open reduction

Answer 2

• approach
  
  • posterior dislocation
    
    • posterior (Kocher-Langenbeck) approach
  • anterior dislocation
    
    • anterior (Smith-Petersen) approach
• technique
  
  • may place patient in traction to reduce forces on cartilage due to incarcerated fragment or in setting of unstable dislocation
  • repair of labral or other injuries should be done at the same time