Hip Reduction Techniques

Hip Reduction Techniques

1. Hip reduction technique Dr. S. A. Medway 1 st June 2017

2. The problem Congenital/ Paed Dislocated Hips Dislocated THRs Charlies Patients Perhaps 5% of Primary THR Up to 30% of Revision THR Beware Constrained Liner THR! Metal ring around acetabular component Need r eduction in OT Dislocated Native Hips - High Energy Trauma Dislocated Hip Resurfacing - Call for Help

3. Considerations Primary survey Other injuries Make the diagnosis Diagnose any complications Procedural sedation Timing

4. Make the diagnosis Posterior Dislocation 90% Mechanism: FLEXION, ADDUCTION, INTERNAL ROTATION Xray : Small Femoral Head, Lesser Trochanter less prominent Usually from posterior approach operation (look for scar) A nterior Dislocation Mechanism: EXTENSION, ABDUCTION, EXTERNAL ROTATION Xray : Large Femoral Head, Lesser Trochanter more prominent Usually from anterior approach operation (becoming more common)

5. General principles Like ALL Dislocations Stop opposing forces Traction & Countertraction Restore the anatomy by re-opposing the joint surfaces

6. GET THE FORCES RIGHT (POSTERIOR DISLOCATION)

7. Technique 1 (the best) allis technique

8. Technique 1 (the best) allis technique (WADDELL VARIANT)

9. Technique 1 (the best) allis technique Allis Video https :// www.youtube.com / watch?v =W89jgZbeBEc&t=141s

10. Technique 2 captain morgan

11. Technique 2 captain morgan Captain Morgan Video https:// www.youtube.com / watch?v = HlMVx-ZWOQg

12. Technique 3 whistler

13. Technique 3 whistler Whistler Video https:// www.youtube.com / watch?v =UxUhW4Zac74

14. Technique 4 east baltimore lift

15. Technique 4 east baltimore lift East Baltimore Lift Video https:// www.youtube.com / watch?v =ZNP1luk1q-Q

16. Technique 5 stimpson method

17. Technique 5 stimpson method Stimpson Example

18. Techniques For anterior dislocation

19. Techniques For anterior dislocation

20. Post reduction Examine Neurovascular status Joint movements Compare medial malleolar heights when leg straight Image again Xray vs. CT Scan Disposition - CCT & Home vs. Ortho Ward Admit vs. Ortho Theatre

21. Complications EARLY Sciatic Nerve Injury Femoral Nerve Injury Femoral Artery Injury Fractures Knee Injury

22. Complications LATE Avascular Necrosis Osteoarthritis Instability / Recurrent Dislocation Complications of Immobilisation