Written by Alex Clark
Spoon Feed
The authors describe a novel reduction method for posterior hip dislocations using a hydraulic lift to apply longitudinal traction on the upper leg. See video link below.
Why does this matter?
Posterior dislocations account for nearly 90% of all hip dislocations. Of note, delayed reduction may result in devastating irreversible nerve injury and avascular necrosis. Current reduction methods (ie. Captain Morgan, Allis, etc.) have high rates of success but can be both resource intensive and physically exhausting.
Do you even lift?
This article describes a novel method for the reduction of posterior hip dislocations using a hospital bed hydraulic lift. The patient is placed supine with pelvic stabilization applied via a belt or manual posterior pressure across the bilateral anterior superior iliac spines. Then, a knotted bedsheet is wrapped around the patient’s knee and fixed to the hydraulic lift. A consistent, gradual increase in longitudinal traction is applied to the leg as the hydraulic lifts upward until the hip is reduced. Apart from initial set-up, the remainder of the procedure can be completely hands-free for the physician. Check-out their video for more details!
Is this another victory for machines over the physician? Not necessarily. Think about the single coverage provider in a remote, resource limited hospital. A hydraulic lift might save a little more than just the physician’s aching back. By offloading the physical burden of the procedure, the physician can focus more on patient comfort, airway concerns that arise, and hemodynamics. There will undoubtedly be logistical issues, including the limited availability of lifts in most ERs, potential excessive lifting forces resulting in fractures or orthopedic hardware loosening, and the lack of tactile feedback. Nonetheless, I am intrigued by this technique. “Why deadlift a femur when you can use a crane?” – an Ortho resident, probably.
Editor’s note: JournalFeed has its own hip reduction video! Check out it out see many other hip reduction options that do not involve the use of cranes. ~Nick Zelt
Source
A new technique for reduction of a posteriorly dislocated hip joint. Am J Emerg Med. 2023 Feb 8;S0735-6757(23)00066-9. doi: 10.1016/j.ajem.2023.01.053. Online ahead of print.
