UMEM Educational Pearls

Category: Orthopedics

Title: Posterior Hip Dislocation

Keywords: Dislocation, reduction, AVN (PubMed Search)

Posted: 8/13/2022 by Brian Corwell, MD
Click here to contact Brian Corwell, MD

The hip joint is a very strong and stable structure requiring great force to produce a dislocation

Most hip dislocations are posterior (80-90%)

Mechanism: MVC generating force onto an adducted flexed hip (most commonly)

Associated injuries occur both locally (acetabular fx) and distant (knee bone and ligamentous)

Significant associated injuries in >70%

The hip joint has a very precarious blood supply.

One of the risk factors for AVN is total dislocation time

<6 hours - 5% incidence

>6 hours – up to 53% incidence

Examine the sciatic nerve carefully with posterior dislocations (10% incidence)

Motor – EHL/ankle dorsiflexion

Sensory – sensation dorsum of foot

There are many reduction maneuvers including the East Baltimore Lift technique

https://www.youtube.com/watch?v=1zvelGbVn04

Demonstrated at 30 seconds in above video

Place patient supine with affected leg flexed to 90 degrees at knee and hip. 2 providers position themselves on opposite sides of the patient and each places their arm under the patient’s calf/popliteal region and their hand on the opposite providers shoulder. A 3^rd person is required to stabilize the pelvis. Axial traction is generated by the providers slowly standing up. Gentle internal and external rotation can facilitate successful reduction