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

Treatment

Hip Dislocation

The primary decision in hip dislocation management is whether or not to reduce the hip in the ED versus obtaining emergent orthopedic surgery consultation for reduction in the operating room. All complex hip dislocations (ie, those with an associated fracture) require emergent orthopedic surgery consultation. Other indications for surgical management include irreducible dislocation, nonconcentric reduction, neurovascular deficit after closed reduction, and associated proximal femur or acetabular fracture causing hip instability. Surgical management ranges from open arthrotomy to minimally invasive hip arthroscopy, which is popular for treating intra-articular hip pathology such as loose bodies, chondral defects, and labral tears.4

For a simple hip dislocation that does not show evidence of femur or acetabular fracture on plain films, prompt reduction should be attempted in the ED. If the decision is made to emergently reduce a native traumatic hip dislocation, it should be performed within 6 hours of the time of injury to decrease the risk of avascular necrosis.49 No more than 3 attempts should be made in the ED, as this can also increase the risk of avascular necrosis and damage the articular cartilage.4

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