Northwestern University Feinberg School of Medicine

Orthopedic Teaching

Pelvis/Hip Case 3 ED Management

Posterior Hip Dislocation


ED Management

  • In major trauma ABC's take priority.
  • Reduction should ideally take place within six hours to reduce the incidence of avascular necrosis.Reduction of dislocated prostheses is not emergent since there is no concern for subsequent osteoarthritis or avascular necrosis.
  • Conscious sedationaids in relaxing the muscles and ligaments surrounding the hip and is usually required.
  • 3 reduction attenpts is usually the limit because there is an increase in avascular necrosis with repeated attempts.
  • After reduction, brace the leg in slight abduction, repeat x rays.

Indications for open reduction:

  • failed closed reduction (about 10%)
  • persistent instability after reduction
  • post-reduction neurovascular compromise
  • femoral neck or shaft fracture