Posted by Matthew Mac Partlin on Wednesday, May 30, 2012

Out of theatre hip reductions are notoriously difficult and usually require a fairly beefy proceduralist (Thank Heaven for orthopods), a good deal of sedation and have a fair degree of risk of injury to both patient and practitioner. A competitor who's had his or her foot braced against the cockpit's firewall for a head on impact runs the risk of a posterior hip joint dislocation, with an associated acetabular fracture risk. Any vascular or neurological compromise that results requires an urgent reduction. So anything that potentially facilitates this maneuvre pre-hospital is worth learning about.

The Annals of Emergency Medicine published a paper (http://www.annemergmed.com/article/S0196-0644(11)01307-2/abstract) in December 2011, reviewing 4 years of hip reductions and focussed particularly on a technique called the "Captain Morgan hip reduction technique" (It's named after a brand of rum and if you look at the bottle's label and the technique, the connection is easy to work out, along with the original demonstrator's choice of tipple). There's a short video of the technique here


The technique has received attention on The Trauma Professional's Blog (http://regionstraumapro.com/post/10201631357) and Graham Walker's G-Mergency blog (http://gmergency.tumblr.com/post/13439884185/presenting-the-captain-morgan-hip-reduction)

It's a technique that could have pre-hospital applicability; being much easier on both patient and proceduralist, compared to the standard technique. However, the technique describes pushing down on the ankle to increase leverage of the hip joint, which potentially increases the torque force across the tibia and fibula with the possibility of fracture. Aditionally, in the Annals paper, there is one case that failed to reduce, which occurred in a patient with an anterior acetabular fracture and a bone fragment in the joint space. This situation would normally be expected to need operative repair and reduction and so the lesson is probably the same as all reductions: If you think you are going to need excessive force to reduce the dislocation, there's probably something missing, such as a diagnosis or a drug; so reassess and consider calling in the back-up.