Reduction Of Posterior Hip Dislocation Research Articles

Comparative study of various anaesthetic blocks for optimal reduction of posterior hip dislocation

Native hip dislocations ideally should be reduced soon as possible To improve long-term outcomes. Avascular necrosis and post- traumatic osteoarthritis can be avoided with timely reduction and fixation of defects, if any. There is still debate on the sedation method and the context of the decrease. Allis outlined the standard procedure for the most frequent dislocation, the posterior dislocation: administering longitudinal tension with internal rotation to the hip. Innovative pain management techniques for patients who undergo planned Orthopedics surgery have received more attention recently. Anaesthesia blocks have been proven to be successful in managing acute trauma-related pain before surgical intervention. In this study, we assess the femoral block technique for the reduction of a posterior hip Dislocation and the post-operative results.

Is novel “PGI technique” worth considering for closed reduction of posterior hip dislocations?

<p>There are numerous approaches for closed reduction of posterior hip dislocations, but the most call for strong and prolonged traction, help stabilizing the pelvis, and difficult placement of the doctor and/or patient. A novel closed reduction procedure that only requires one surgeon to complete safely and effectively the hip reduction and does not require traction-counter traction or unique posture of patient. The 11 patients, with a mean age of 34.1 years, underwent reduction. Five type I, five type II, and one type III dislocations consisted our study. Closed reduction was accomplished in 11 hips (100%), with all requiring just one try. This innovative method is an easy, secure, and efficient replacement of other techniques for closed reduction of posterior hip dislocations. It can be performed by a single surgeon, requires no traction, and can be very helpful for patients with polytrauma as well as those patients who have pelvic fractures and ipsilateral lower limb injuries.</p>

Failed reduction of posterior hip dislocation accompanied by femoral head fracture: causes and resolving strategy.

We investigated the causes of failure of the Allis manoeuvre for posterior hip dislocations with an associated Pipkin type I femoral head fractures. The effectiveness of a modified Allis manoeuvre was also evaluated. From January 2013 to December 2016, we enrolled five patients with a posterior hip dislocation associated by a Pipkin type I femoral head fracture who were treated initially with the Allis manoeuvre that subsequently failed. Radiographic evaluations were performed to determine the cause of failure, and then a modified Allis manoeuvre was performed. During this procedure, the hip and knee joints of the injured lower limb were both flexed to 90°, and the leg was pulled posteriorly following an upward force to reduce the dislocation. Reduction was assessed by radiographic evaluation. In all patients, the fractured femoral head was incarcerated on the superior edge of the posterior rim of the acetabulum, resulting in failure of the conventional Allis manoeuvre. Satisfactory reduction was achieved with a modified Allis manoeuvre. The mean follow-up duration was 31months. The femoral head fracture healed after four months on average. The mean Harris score was 91 at the final follow-up. Re-dislocation or femoral head necrosis was not observed. For posterior hip dislocations associated with a Pipkin type I femoral head fracture, failed reduction is often caused by incarceration of the fractured femoral head on the superior edge of the posterior rim of the acetabulum. The modified Allis manoeuvre can effectively reduce the combined injury in a closed fashion.

A Detailed Review of Hip Reduction Maneuvers: A Focus on Physician Safety and Introduction of the Waddell Technique.

Dislocation of the hip is a well-described event that occurs in conjunction with high-energy trauma or postoperatively after total hip arthroplasty. Bigelow first described closed treatment of a dislocated hip in 1870, and in the last decade many reduction techniques have been proposed. In this article, we review all described techniques for the reduction of hip dislocation while focusing on physician safety. Furthermore, we introduce a modified technique for the reduction of posterior hip dislocation that allows the physician to adhere to the back safety principles set for by the Occupational Safety and Health Administration.

A New Technique for Closed Reduction of Traumatic Posterior Dislocations of the Hip: The ‘PGI Technique’

Many techniques have been described for closed reduction of posterior hip dislocations, but most require forceful and sustained traction, assistants to stabilise the pelvis and awkward positioning of the surgeon and/or the patient. We describe a new technique of closed reduction that does not need traction-countertraction or special positioning and can be safely and effectively performed by one surgeon.Fifteen patients, mean age 36.4 years, were subjected to reduction. There were five type I, four type II and six type III dislocations; ipsilateral injuries included one knee dislocation with patellar fracture, and two cases of tibia fracture. Closed reduction was achieved in 14 (93.3%) hips, with single attempt successful in 13 cases, while one needed two attempts. One hip could not be reduced due to incarceration of a posterior wall fragment and was managed by open reduction and internal fixation.Our new technique has proved to be a reliable, safe and effective alternative for closed reduction of posterior hip dislocations. It can be carried out by one surgeon, does not need traction and can be especially beneficial in polytrauma patients and also in those patients who have pelvic fractures and ipsilateral lower limb injuries.

Initial treatment of traumatic hip dislocations in the adult.

The initial treatment of traumatic hip dislocations is critical to successful treatment of this injury. It generally is agreed that prompt reduction with the patient under anesthesia or sedation is required. Delay in reduction of posterior hip dislocations is associated with avascular necrosis of the hip. Occasionally the hip dislocation will be irreducible. Various methods to reduce hip dislocations have been described in the literature. The superiority of one particular technique has not been shown and the choice of reduction maneuver must be tailored to the condition of the patient. Traumatic hip dislocations often are associated with multiple injuries that may limit the options available for initial treatment of the hip dislocation. Adherence to general principles of skeletal reduction will increase the ease of reduction and decrease the risk of iatrogenic injury during reduction. Additional clinical and radiographic evaluation of the hip that was reduced often is necessary to determine whether subsequent open treatment is required.

Reduction of posterior hip dislocations in the lateral position using traction-countertraction: safer for the surgeon?

Closed reduction of a hip dislocation is a physically demanding task for the orthopaedic surgeon. The most commonly used methods for reduction of the hip involve vigorous axial traction on the lower extremity with the patient in the supine position, using an assistant who attempts to hold the pelvis down. The surgeon generally stands over the patient to pull up on the bent knee, which puts the surgeon at risk for a low back injury and, if done while the patient remains on a stretcher, can put the surgeon at risk for a fall from a height. Reduction in the prone position is advocated by some, but caring for the sedated patient in the prone position can be difficult and the patient's pelvis tends to roll off the edge of the stretcher, preventing the achievement of hip flexion, which is desirable in achieving reduction. We describe a traction-countertraction technique that appears to be significantly less dangerous for the surgeon. In this technique the hip is reduced with the patient remaining on the stretcher in the lateral position. In addition, fluoroscopy can be carried out during the reduction maneuver, and the images can be quite helpful in adjusting the direction of manipulative forces.

The East Baltimore Lift: a simple and effective method for reduction of posterior hip dislocations.

A supine technique for reducing posterior dislocations of the hip is presented. We believe this technique provides more controlled traction than do other maneuvers and have found it to be a safe and effective method to reduce the posteriorly dislocated hip.