Test Your Knowledge: Managing Dislocations of the Hip, Knee, and Ankle in the ED
January 9, 2020


Posted by Andy Jagoda, MD in: Brain Tease , trackback

Dislocation of the major joints of the lower extremities–hip, knee, and ankle–can occur due to motor-vehicle crashes, falls, and sports injuries. These are painful presentations in the trauma ED that must be managed quickly to avoid morbidity, disability, and even possible amputation.

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Points from Managing Dislocations of the Hip, Knee, and Ankle in the Emergency Department (Trauma CME):

  • 90% of hip dislocations are posterior; 10% percent are anterior.
  • Typically, an AP pelvic radiograph is adequate to diagnose a hip dislocation. Judet views are help?ful in diagnosing associated fractures.
  • Traumatic dislocations of the native hip should be reduced within 6 hours to reduce the risk of avascular necrosis and posttraumatic arthritis.
  • The Allis, Bigelow, Captain Morgan, Rocket Launcher, and East Baltimore Lift techniques can all be used to reduce a hip dislocation. None have proven to be superior to the others; the choice can be made according to provider capability and preference.
  • All hip reduction methods can be used on both native and prosthetic hips.
  • Consider an ultrasound-guided fascia iliaca com?partment block to augment and reduce proce?dural sedation and analgesia.
  • All hip fracture dislocations should be deferred to orthopedic surgery.
  • After reduction of a native hip dislocations, a CT scan should be obtained. The patient will need to be admitted to the hospital.
  • Many knee dislocations spontaneously reduce. Maintain a low threshold of suspicion for this injury, as missing a knee dislocation could have catastrophic consequences.
  • In any knee dislocation with a pulse deficit, perform immediate reduction without imaging. Delays longer than 8 hours have a higher inci?dence of amputation.
  • After reduction of the dislocated knee, patients should be admitted for serial vascular examina?tions or vascular imaging should be obtained. Compartment syndrome is a delayed complica?tion of knee dislocations.
  • Ankle dislocations require immediate recognition and prompt reduction, as they can be associated with significant neurovascular, skin, and soft-tissue complications.
  • Subtalar dislocations are rare, but appear similar to ankle dislocations. Attempting to reduce a subtalar dislocation before imaging may lead to worsening of the dislocation.
  • Emergent orthopedic consultation and post-reduction CT are necessary after reduction of a dislocated ankle.

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