How to treat hip dislocation?

When you encounter the problem of knee dislocation, the first thing you need to pay attention to in terms of treatment methods is reduction. This is mainly an emergency treatment measure taken for recent dislocation. Through reduction techniques, the patient's joint is restored to its original position, so that it can recover as soon as possible and prevent problems.

1. Treatment of recent dislocation

(1) Methods for reducing posterior dislocation ① Question mark method (Bigelow's method) Under spinal anesthesia, the patient lies on his back, the assistant fixes the pelvis, and the hip and knee are flexed to 90 degrees. The surgeon holds the ankle of the affected limb with one hand and places the other forearm on the popliteal fossa to pull upward. First, the hip joint is flexed, adducted, and internally rotated (so that the femoral head leaves the ilium). Then, while continuing to pull, the joint is externally rotated, abducted, and straightened, so that the femoral head slides into the acetabulum and is reduced (the assistant can help push the femoral head into the acetabulum). Because the continuous movement of the thigh during reduction is in the shape of a "?", like a question mark, it is called the "question mark method" of reduction. When reducing the left side of the posterior dislocation, the continuous movement of the thigh is like a positive "question mark", conversely, the right side of the posterior dislocation is a reverse "question mark". ② Pulling method (Allis method) The patient lies on his back, and the assistant's movements and the surgeon's position are the same as the above method. During reduction, the surgeon first flexes the affected hip and knee joints to 90° to relax the iliofemoral ligament and knee flexor muscles. Then, hold the calf with one hand and press it down, and use the other forearm to wrap around the back of the knee and pull it upward to move the femoral head forward and close to the rupture in the posterior wall of the joint capsule. At the same time, rotate the femoral shaft inwards and outwards to allow the femoral head to slide into the acetabulum. The assistant can simultaneously push the femoral head toward the acetabulum to reduce it. A noticeable sound can often be heard or felt during resetting. This method is safer. ③ Treatment after reduction: After reduction, unilateral hip spica cast can be used for fixation for 4 to 5 weeks (or the affected limb can be fixed with a sandbag in supine position so that it is slightly abducted and internally rotated). Later, crutches can be used for early activities, but the affected side cannot bear weight. After 6 to 8 weeks, X-ray examination can be performed, and weight-bearing walking can be allowed only when there is no femoral head necrosis. ④ Indications for surgical reduction: If manipulation cannot reduce the fracture, timely surgical reduction should be considered. Large fractures of the upper rim of the acetabulum require surgical reduction and internal fixation.

(2) The treatment principles for anterior dislocation are the same as before, except that the direction of manipulation is opposite. The treatment after reduction is also the same.

(3) Central dislocation should be reduced by bone traction for 4 to 6 weeks. If severe traumatic arthritis occurs in the late stage, artificial joint replacement or arthrodesis may be considered.

2. Old dislocation of the hip

Because the acetabulum is filled with fibrous scars and the surrounding soft tissues are contracted, manual reduction is not easy to succeed. The treatment method can be determined based on the duration of dislocation, local lesions and the condition of the injured person. If the dislocation has not lasted for more than three months, manual reduction may be attempted. First perform bone traction for 1 to 2 weeks to pull the femoral head down to the rim of the acetabulum, and then try to gently move the hip joint under anesthesia to loosen adhesions. After sufficient loosening is achieved, reduce it according to the technique for fresh dislocation. But be careful not to be rough to avoid fractures. If manual reduction is unsuccessful or the dislocation has lasted for more than three months, surgical reduction should be performed. For patients with severe damage to the joint surface, hip fusion or artificial joint replacement can be performed based on the patient's occupation.