Joint reductions are one of my favorite emergency department procedures.
The pathology is obvious to both the patient and the physician.
The treatment is clear. Put the bone back in joint.
The success of the procedure is evident. The joint is back in normal alignment.
Some joint reductions are easier than others.
Fingers are very easy.
Shoulders are not difficult, not easy, but almost always successful.
Hips can be challenging. Sometimes they refuse to get reacquainted with their joint.
Hip reductions are one of those procedures that can injure the physician. One method involves standing on the gurney and yanking the leg. This can result in a tweaked back, a pulled groin muscle, and the occasional somersault off the gurney. Not elegant.
My favorite method is less gorilla, more investment banker circa 2008. You know, leveraged. You can pull with all your might or you can think like a 3000 BC Egyptian building a pyramid.
The technique I use is called the Captain Morgan.
Use brevital (not rum) or another concoction to get the perfect level of sedation.
Adopt the stance of the pirate and use your knee as the fulcrum to lever the hip back into place.
It doesn't work 100% of the time. But nothing does. There are 300 lb athletes where the hip pops in, and there are 90 y old ladies where no procedure short of paralysis and intubation will work.
Greg Hendey, one of my mentors, gives an excellent talk on orthopedic reductions. Here is a direct link to the pdf of his lecture at the American College of Emergency Physician's Scientific Assembly. The line drawing is from that handout.
That is a sweet illustration.
Posted by: Ted | February 20, 2009 at 12:39