Reduction of posterior dislocation of the hip in the prone position

Abstract

A posteriorly dislocated hip is usually reduced with the patient supine, and a recent brief report recommended increased adduction and flexion (Bassi, Ahuja and Singh 1992). We describe an easy method of reduction in the prone position without anaesthesia. This has been successful in four patients aged from 17 to 28 years, three men and one woman, with dislocations classified as type I (3) or type II (Thompson and Epstein 1951). Method. An intravenous muscle relaxant is given and the conscious patient is placed in the prone position over the end of a table, so that the hips are flexed to 90#{176}. Then the ankle of the affected leg is grasped to flex the patient’s knee. The surgeon’s knee is then placed on the patient’s calf, and the gentle transfer of body-weight provides downward force (Fig. 1). No extra power is required to achieve reduction, which is confirmed by an audible snap. The only assistance required is in turning the patient ; the whole procedure can be performed in the accident department. Discussion. This method was used by the late father of the second author in the coalmines of Limburg, often in the very difficult circumstances of a mine shaft, with his patient on top of a coalwagon. The principle of the method was described by Stimson in 1908, but he did not use the force of bodyweight, which makes this method very easy to perform.