Reduction of posterior hip dislocations in the lateral position using traction-countertraction: safer for the...

Closed reduction of a hip dislocation is a physically demanding task for the orthopaedic surgeon. The most commonly used methods for reduction of the hip involve vigorous axial traction on the lower extremity with the patient in the supine position, using an assistant who attempts to hold the pelvis down. The surgeon generally stands over the patient to pull up on the bent knee, which puts the surgeon at risk for a low back injury and, if done while the patient remains on a stretcher, can put the surgeon at risk for a fall from a height. Reduction in the prone position is advocated by some, but caring for the sedated patient in the prone position can be difficult and the patient's pelvis tends to roll off the edge of the stretcher, preventing the achievement of hip flexion, which is desirable in achieving reduction. We describe a traction-countertraction technique that appears to be significantly less dangerous for the surgeon. In this technique the hip is reduced with the patient remaining on the stretcher in the lateral position. In addition, fluoroscopy can be carried out during the reduction maneuver, and the images can be quite helpful in adjusting the direction of manipulative forces.