> [!treatment] reduction techniques > **Allis manoevre:** > - stand on bed, hip & knee to 90 deg, operator pulls up > - risk to [[Neurovascular assessment|sciatic nerve]] > > **Captain Morgan:** > - patient supine, pelvis fixed, flex hip and knee to 90 deg. patient's lower leg rests on examiner's knee. provide upward force to hip by flexing foot to lift with calf > > **Whistler:** > - patient supine, hip flexed, adducted. examiner hand under affected knee, resting on flexed opposite knee (fulcrum). force applied downward on affected lower leg > > #### complications > - sciatic nerve injury > - avascular necrosis > - arthritis - must be reduced quickly to ↓ risk of neurovascular complications and avascular necrosis of the femoral head (nb this is seen in [[Perthes' disease]] in paediatric limp) - should be ==reduced within 6 hours== - [[Neurovascular assessment|sciatic nerve injury]] in ~10% - 90% posterior; 10% anterior - classic injury for posterior dislocation is a "dashboard" injury: force transmitted into knee while hip flexed and adducted - disruption of the posterior rim of acetabulum can predispose to recurrent dislocations ![[Pasted image 20241212191402.png| posterior hip dislocation with superior and inferior acetabular rim fractures]] **clinical features** *posterior dislocation:* - shortened - adducted - internally rotated ![[Pasted image 20241212192744.png]] ![[Pasted image 20241212191124.png]] *anterior hip dislocation* (rare) - shortened - ABducted - externally rotated ## Reduction techniques for posterior dislocation - captain Morgan - allis manoevre - operator stands on bed - graps ankle btwn operator's knee to provide a fulcrum - axial traciton applied behind knee with increasing force and a rocking motion - additional lateral traction to proximal femur optional - whistler technique - unaffected knee slightly flexed - physician's elbow placed beneath affected knee and grasps unaffected knee with same hand - affeckted ankle grasped with other hand and immobilised - arm used as lever to raise knee on affected limb ![[Pasted image 20241212192843.png]] ^ Allis manoeuvre ![[Pasted image 20241212192934.png]] The Bigelow maneuver for reduction of posterior hip dislocation. A. The physician applies upward traction on the femur while an assistant stabilizes the pelvis. B. The hip is externally rotated and extended while the femur is distracted. ![[Pasted image 20241212193022.png|Captain Morgan]] ![[Pasted image 20241212193131.png|Captain Morgan's namesake:]] ## Post-reduction care: Because flexion and adduction cause posterior dislocations, the opposite, extension and abduction, protect against it. This can be achieved with a triangular “abduction pillow” ## anterior dislocation reduction - flex knee and hip to 90 deg - apply traction along femur - assistant applies posteriorly directed pressure to femoral head as the hip is abducted - may need muscle relaxant and general anaesthesia