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Fri Jul 27 06:01:41 BST 2007

Mathias & Pret

Somehow the original mail about these hip problems did not seem to get to some of us on the list; I have been suspecting for some time that not all postings to trauma-list get to all the members! (Karim and Sue etc please note!)

Tim

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Mathias Kalkum
Sent: Thursday, July 26, 2007 8:56 PM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Hip Reductions

Pret,

seems nobody is in the mood to answer your question, so I'll give it my
best try. Let me assume, you do not have ortho service available at any
time, here is, what I would suggest:
> Interested in various local approaches to the dislocated hip:
> specifically, rules or guidelines on timing of reductions...
>
> ... in the absence of immediate orthopedic consultation?
Reduce the hip in general anesthesia (and usually you'll be happy if the anesthetist adds a dose of relaxant). 

> ... in the context of unstable pelvis or major acetabular injury?
>   
Make sure, this is your worst problem - else address the main topics
first: active bleeding etc. Otherwise proceed to step 1 above. Be aware
that bleeding may start after you have successfully reduced the luxation...
> ... in the context of femoral head/neck fractures?
>   
"Young" ones (well, you know, it depends... young may mean something
between 40 and 60 y/o in this context): immediate reduction and
appropriate fixation of the fracture (be it screws, DHS, etc.). In the
elderly immediate reduction and definite operation within 24 ours.

My two cents.

If you have finished your draft, maybe you want to share the results
with us.

Mathias
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Hip Reductions