<unk> s are a medical emergency, requiring timely placement of the femoral head back into the acetabulum (reduction) in order to reduce the risk of osteonecrosis of the femoral head. Most professionals recommend closed reduction (nonoperative) barring operative indications such as irreducible dislocation, delayed presentation, non-concentric reduction, fracture requiring excision and/or open reduction internal fixation (ORIF) among other operative indications. Prognosis is worsened if reduction is delayed more than 6 hours. If the reduction is stable, the patient can proceed to protective weight bearing which includes crutch-assisted walking (ambulation) with weight bearing as tolerated for 4-6 weeks succeeding a short period of bed rest. If reduction is unstable, 4-6 weeks of skeletal traction is necessary before protective weight bearing. Nonoperative The<unk>  should be reduced as quickly as possible to reduce the risk of osteonecrosis of the femoral head. This is done through manual traction of the thigh inline with the dislocation under general anesthesia and muscle relaxation, or conscious sedation. Fractures of the femoral head and other loose bodies should be determined prior to reduction. Of note, femoral neck fractures and incarcerated fracture fragments preventing joint reduction are contraindications. Common closed reduction methods include the Allis method, Stimson Gravity Technique, and the Bigelow maneuvers. Once reduction is completed, management becomes less urgent and appropriate workup including CT scanning can be completed. Operative Open (surgical) reduction indications include an irreducible dislocation, fracture with fragments preventing congruent reduction, fracture requiring an ORIF, delayed presentation, and non-concentric reduction. Approaches to surgical reductions include the posterior approach for posterior dislocations ( Kocher-Langenbeck), and the anterior (Smith-Petersen) approach for anterior dislocations. A CT scan or Judet views should be obtained prior to transfer to the surgical suite.
Hip dislocation
Hip dysplasia
Hip fracture
Elbow fracture
Acetabular fracture
Humerus fracture
Knee dislocation
Femoral fracture