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Lai PJ, Lai CY, Tseng IC, Su CY, Hsu YH, Chou YC, Yu YH. A retrospective study of hip posterior fracture-dislocation: closed reduction at the emergency department or in the operation theater? J Orthop Traumatol 2022; 23:55. [PMID: 36459307 PMCID: PMC9718901 DOI: 10.1186/s10195-022-00677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND For hip posterior fracture-dislocation, the current consensus is to perform joint reduction within 6 h to prevent sequelae. However, whether a closed reduction (CR) should be performed at the emergency department (ED) or in the operation theater (OT) remains debatable. We aimed to assess the incidence and factors predictive of CR failure at the ED in patients with hip posterior fracture-dislocation. METHODS Patients with hip posterior fracture-dislocation between 2009 and 2019 were included. Age, sex, body mass index (BMI), injury severity score, new injury severity score, time from injury to first reduction attempt (TIR), presence of associated femoral head fracture, posterior wall marginal impaction, and posterior wall fragment size were compared between patients with CR success and patients with CR failure at the ED. RESULTS Fifty-five patients with hip posterior fracture-dislocation experienced CR attempts at the ED and were enrolled in the study. Thirty-eight (69.1%) hips were reduced successfully at the ED, and 17 (30.9%) experienced failure. No significant differences in age, sex, BMI, presence of femoral head fracture, marginal impaction, or size of the posterior wall fragment were found between the groups. TIR was significantly shorter in the successful CR group (2.24 vs. 4.11 h, p = 0.01). According to receiver operating characteristic curve analysis, 3.5 h was the cut-off time. CONCLUSIONS For patients with hip posterior fracture-dislocation, TIR was a critical factor for successful CR. If the time interval exceeds 3.5 h from injury, the success rate of bedside CR at the ER is likely to decrease, and the OT should be prepared in case of failed bedside CR. LEVEL OF EVIDENCE III
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Affiliation(s)
- Po-Ju Lai
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302 Tao-Yuan City, Taiwan
| | - Chih-Yang Lai
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302 Tao-Yuan City, Taiwan
| | - I-Chuan Tseng
- The Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan branch, Tao-Yuan City, Taiwan
| | - Chun-Yi Su
- The Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung City, Taiwan
| | - Yung-Heng Hsu
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302 Tao-Yuan City, Taiwan
| | - Ying-Chao Chou
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302 Tao-Yuan City, Taiwan
| | - Yi-Hsun Yu
- Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, 33302 Tao-Yuan City, Taiwan
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Grant J, Beck S, Lambie B. Posterior hip dislocation reduction revisited. Emerg Med Australas 2021; 33:1128-1129. [PMID: 34486796 DOI: 10.1111/1742-6723.13864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Affiliation(s)
- James Grant
- Department of Orthopaedic Surgery, Dunedin Hospital, Dunedin, New Zealand.,Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Sierra Beck
- Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand.,Department of Emergency Medicine, Dunedin Hospital, Dunedin, New Zealand
| | - Bruce Lambie
- Otago Medical School - Dunedin Campus, University of Otago, Dunedin, New Zealand.,Department of Emergency Medicine, Dunedin Hospital, Dunedin, New Zealand
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[Emergency treatment of dislocation of large joints]. Unfallchirurg 2021; 124:391-406. [PMID: 33954844 DOI: 10.1007/s00113-021-01014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Joint dislocations are always accompanied by rupture of the joint capsule. Depending on the forces exerted on the joint as well as individual bone quality, fractures (dislocation fractures) and injuries to ligaments occur. As blood vessels and nerves can also be damaged, reduction is an urgent measure. Only impaired peripheral perfusion, loss of motor function or sensation justify reduction without radiological documentation. As reduction can be a painful procedure, analgosedation is nearly always necessary. Evidence for superiority of individual maneuvers is weak. Reduction is followed by immobilization and documented by another control X‑ray. Follow-up treatment depends on concomitant injuries, age and individual demands on joint function. Even with correct follow-up treatment, deficits often persist. This article deals with the diagnostics and treatment of dislocations of the shoulder, elbow, hip, patella and knee.
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Notfallbehandlung von Luxationen großer Gelenke. Notf Rett Med 2020. [DOI: 10.1007/s10049-020-00742-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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New reduction technique for posterior prosthetic hip dislocation: a case report demonstrating ease of reduction with this technique in larger patients. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Traumatic injuries of the hip and pelvis are commonly encountered in the emergency department. This article equips all emergency medicine practitioners with the knowledge to expertly diagnose, treat, and disposition these patients. Pelvic fractures occurring in young patients tend to be associated with high-energy mechanisms and polytrauma. Pelvic and hip fractures in the elderly are often a result of benign trauma but are associated with significant morbidity and mortality.
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Affiliation(s)
- Jason V Brown
- Emergency Medical Services, United States Air Force, 96TW/SGOE, 307 Boatner Road, Eglin AFB, FL 32542, USA.
| | - Sharleen Yuan
- Department of Emergency Medicine, University of Maryland Medical Center, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA
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Giordano V, Giordano M, Glória RC, de Souza FS, di Tullio P, Lages MM, Koch HA. General principles for treatment of femoral head fractures. J Clin Orthop Trauma 2019; 10:155-160. [PMID: 30705552 PMCID: PMC6349681 DOI: 10.1016/j.jcot.2017.07.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/06/2017] [Accepted: 07/27/2017] [Indexed: 12/21/2022] Open
Abstract
Femoral head fractures occur almost exclusively as a result of a traumatic hip dislocation. Treatment is typically an emergency and includes the reduction of the dislocated hip under anesthesia. As a rule, the earlier the reduction, the better the outcome. Open reduction and internal fixation of the fracture of the femoral head is the treatment of choice for most young patients. In some selected cases when there is a very small fragment located in the region below the fovea, removal should be indicated. In elderly patients and those who experience severe femoral head impaction, it is preferable to perform a total hip replacement. Despite optimal management, the rate of complications after femoral head fractures may reach as high as 50%. In the present study, the authors review the general principles of management of patients with femoral head fractures.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil,Núcleo Especializado de Ortopedia e Traumatologia, Clínica São Vicente, Rio de Janeiro, RJ, Brazil,Corresponding author at: Rua João Borges 204, Clínica São Vicente, Gávea, 22451-100, Rio de Janeiro, RJ, Brazil.
| | - Marcos Giordano
- Divisão de Ortopedia e Traumatologia, Hospital de Força Aérea do Galeão, Rio de Janeiro, RJ, Brazil,Núcleo Especializado de Ortopedia e Traumatologia, Clínica São Vicente, Rio de Janeiro, RJ, Brazil
| | - Renato Caravellos Glória
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil,Núcleo Especializado de Ortopedia e Traumatologia, Clínica São Vicente, Rio de Janeiro, RJ, Brazil
| | - Felipe Serrão de Souza
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil,Núcleo Especializado de Ortopedia e Traumatologia, Clínica São Vicente, Rio de Janeiro, RJ, Brazil
| | - Paulo di Tullio
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil,Núcleo Especializado de Ortopedia e Traumatologia, Clínica São Vicente, Rio de Janeiro, RJ, Brazil
| | - Marco Martins Lages
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil,Núcleo Especializado de Ortopedia e Traumatologia, Clínica São Vicente, Rio de Janeiro, RJ, Brazil
| | - Hilton Augusto Koch
- Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Abstract
Background Dislocation of the hip is a well-described event that occurs in conjunction with high-energy trauma or postoperatively after total hip replacement. Methods In this review, the types, causes, and treatment modalities of hip dislocation are discussed and illustrated, with particular emphasis on the assessment, treatment, and complications of dislocations following total hip replacement. Results Hip dislocations are commonly classified according to the direction of dislocation of the femoral head, either anterior or posterior, and are treated with specific techniques for reduction. Generally, closed reduction is the initial treatment method, usually occurring in the emergency room. Bigelow first described closed treatment of a dislocated hip in 1870, and since then many reduction techniques have been proposed. Each method has unique advantages and disadvantages. Anterior hip dislocation is commonly reduced by inline traction and external rotation, with an assistant pushing on the femoral head or pulling the femur laterally to assist reduction. Posterior hip dislocations are the most common type and are reduced by placing longitudinal traction with internal rotation on the hip. Conclusion Patients with hip dislocations must receive careful diagnostic workup, and the treating physician must be well versed in the different ways to treat the injury and possible complications. Timely evaluation and treatment, including recognizing the potential complications, are necessary to offer the best outcome for the patient.
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Hip Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med 2018; 54:339-347. [PMID: 29331493 DOI: 10.1016/j.jemermed.2017.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/03/2017] [Accepted: 12/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hip dislocations are a common presentation in the Emergency Department (ED) and require urgent reduction to reduce the risk of avascular necrosis. Over 90% of all dislocations can successfully be reduced in the ED and there is evidence that cases awaiting operative reduction result in significant delays. DISCUSSION While there is limited data comparing specific techniques, the individual success rates of most maneuvers range from 60-90%. Additionally, each technique has distinct advantages and limitations associated with its use. CONCLUSIONS It is important for Emergency Physicians to be familiar with several different reduction techniques in case the initial reduction attempt is unsuccessful or patient characteristics limit the use of certain maneuvers. This article reviews a number of reduction techniques for hip dislocations, variations on these techniques, and advantages and disadvantages for each approach.
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A Novel Technique for the Bedside Reduction of the Posterior Hip Dislocation. Tech Orthop 2017. [DOI: 10.1097/bto.0000000000000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Waddell BS, Mohamed S, Glomset JT, Meyer MS. A Detailed Review of Hip Reduction Maneuvers: A Focus on Physician Safety and Introduction of the Waddell Technique. Orthop Rev (Pavia) 2016; 8:6253. [PMID: 27114811 PMCID: PMC4821229 DOI: 10.4081/or.2016.6253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 10/13/2015] [Indexed: 11/23/2022] Open
Abstract
Dislocation of the hip is a well-described event that occurs in conjunction with high-energy trauma or postoperatively after total hip arthroplasty. Bigelow first described closed treatment of a dislocated hip in 1870, and in the last decade many reduction techniques have been proposed. In this article, we review all described techniques for the reduction of hip dislocation while focusing on physician safety. Furthermore, we introduce a modified technique for the reduction of posterior hip dislocation that allows the physician to adhere to the back safety principles set for by the Occupational Safety and Health Administration.
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Affiliation(s)
| | | | - John Trey Glomset
- Department of Orthopedics, Ochsner Clinic Foundation , New Orleans, LA, USA
| | - Mark S Meyer
- Department of Orthopedics, Ochsner Clinic Foundation, New Orleans, LA, USA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA
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Desai N, Caperell KS. Joint Dislocations in the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Dan M, Phillips A, Simonian M, Flannagan S. Rocket launcher: A novel reduction technique for posterior hip dislocations and review of current literature. Emerg Med Australas 2015; 27:192-5. [PMID: 25846901 DOI: 10.1111/1742-6723.12392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We provide a review of literature on reduction techniques for posterior hip dislocations and present our experience with a novel technique for the reduction of acute posterior hip dislocations in the ED, 'the rocket launcher' technique. METHODS We present our results with six patients with prosthetic posterior hip dislocation treated in our rural ED. We recorded patient demographics. The technique involves placing the patient's knee over the shoulder, and holding the lower leg like a 'Rocket Launcher' allow the physician's shoulder to work as a fulcrum, in an ergonomically friendly manner for the reducer. We used Fisher's t-test for cohort analysis between reduction techniques. RESULTS Of our patients, the mean age was 74 years (range 66 to 85 years). We had a 83% success rate. The one patient who the 'rocket launcher' failed in, was a hemi-arthroplasty patient who also failed all other closed techniques and needed open reduction. When compared with Allis (62% success rate), Whistler (60% success rate) and Captain Morgan (92% success rate) techniques, there was no statistically significant difference in the successfulness of the reduction techniques. There were no neurovascular or periprosthetic complications. CONCLUSION We have described a reduction technique for posterior hip dislocations. Placing the patient's knee over the shoulder, and holding the lower leg like a 'Rocket Launcher' allow the physician's shoulder to work as a fulcrum, thus mechanically and ergonomically superior to standard techniques.
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Affiliation(s)
- Michael Dan
- Emergency Department, Maitland Hospital, Maitland, New South Wales, Australia
| | - Alfred Phillips
- Orthopaedics Department, Gold Coast Hospital, Gold Coast, Queensland, Australia
| | - Marcus Simonian
- Emergency Department, Maitland Hospital, Maitland, New South Wales, Australia
| | - Scott Flannagan
- Emergency Department, Maitland Hospital, Maitland, New South Wales, Australia
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Vinson DR, Hoehn CL. Sedation-assisted Orthopedic Reduction in Emergency Medicine: The Safety and Success of a One Physician/One Nurse Model. West J Emerg Med 2013; 14:47-54. [PMID: 23447756 PMCID: PMC3582522 DOI: 10.5811/westjem.2012.4.12455] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/09/2012] [Accepted: 04/30/2012] [Indexed: 02/01/2023] Open
Abstract
Introduction Much of the emergency medical research on sedation-assisted orthopedic reductions has been undertaken with two physicians––one dedicated to the sedation and one to the procedure. Clinical practice in community emergency departments (EDs), however, often involves only one physician, who both performs the procedure and simultaneously oversees the crendentialed registered nurse who administers the sedation medication and monitors the patient. Although the dual-physician model is advocated by some, evidence in support of its superiority is lacking. Methods: In this electronic health records review we describe sedation-assisted closed reductions of major joints and forearm fractures in three suburban community EDs. The type of procedure and sedation medication, need for specialty assistance, success rates, and intervention-requiring adverse events are reported. Results: During the 18-month study period, procedural sedation was performed 457 times on 442 patients undergoing closed reduction for shoulder dislocations (n = 111), elbow dislocations (n = 29), hip dislocations (n = 101), and forearm fractures (n = 201). In the vast majority of this cohort (98.4% [435/442]), a single emergency physician simultaneously managed both the procedural sedation and the initial orthopedic reduction without the assistance of a second physician. The reduction was successful or satisfactory in 96.6% (425/435; 95% confidence interval [CI], 95.8–98.8%) of these cases, with a low incidence of intervention-requiring adverse events (2.8% [12/435]; 95% CI, 1.5–4.8%). Conclusion: Sedation-assisted closed reduction of major joint dislocations and forearm fractures can be performed effectively and safely in the ED using a one physician/one nurse model. A policy that requires a separate physician (or nurse anesthetist) to administer medications for all sedation-assisted ED procedures appears unwarranted. Further research is needed to determine which specific clinical scenarios might benefit from a dual-physician approach.
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Affiliation(s)
- David R Vinson
- Kaiser Permanente Roseville Medical Center, Department of Emergency Medicine, Roseville, California ; The Permanente Medical Group, Oakland, California
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The Captain Morgan Technique for the Reduction of the Dislocated Hip. Ann Emerg Med 2012; 60:135-6; author reply 136. [DOI: 10.1016/j.annemergmed.2012.01.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 01/12/2012] [Accepted: 01/23/2012] [Indexed: 11/24/2022]
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