Post-Reduction Management of Hip Dislocation

Diagnostic Imaging

• The American College of Radiology recommends obtaining pelvic radiographs immediately after reduction to confirm concentric reduction and detect intra-articular fragments or associated fractures 1, 2
• Consider non-contrast CT scan of the hip if there are visible posterior acetabular wall fractures, if closed reduction failed, or if radiographs show joint incongruity 1, 2, 3
• CT scans have better sensitivity (87.3%) for detecting intra-articular fragments than plain radiographs, although up to 43.3% of patients with negative CT scans may have small fragments 1, 3

Protocol for Mobilization

• The American College of Radiology suggests that early mobilization (average 9 days) with partial weight-bearing, progressing to full weight-bearing at 3 months, reduces the risk of complications from prolonged immobility 1, 2
• Early mobilization does not increase early complications compared to prolonged traction, allows for faster return to work, and reduces the risk of complications from prolonged immobility 1, 2

Specific Protocol for Rest and Mobilization

• Relative rest for 3-9 days with multimodal analgesia, considering nerve blocks to facilitate early mobilization 4

Contraindications for Early Mobilization

• If there are unstable acetabular fractures that require surgery 1, 2
• If the reduction is not concentric on post-reduction images 1
• If there are large intra-articular fragments that prevent stable reduction 1, 2

Imaging Follow-up

• Do not use bone scintigraphy, contrast-enhanced CT, or contrast-enhanced MRI for routine post-reduction follow-up 1, 2
• Consider non-contrast MRI only if there is suspicion of abductor tendon, muscle, or ligament injuries that may compromise stability 1, 3, 5

Management of Hip Dislocation

Mobilization Strategy

• Excessive flexion and internal rotation of the hip should be resisted, as recommended by the Anaesthesia guideline society, to prevent redislocation 6