ABSTRACT
The dislocation must be reduced as soon as possible under general anaesthesia. In the vast majority of cases this is performed closed, but if this is not achieved after two or three attempts an open reduction is required. An assistant steadies the pelvis; the surgeon starts by applying traction in the line of the femur as it lies (usually in adduction and internal rotation), and then gradually flexes the patient’s hip and knee to 90 degrees, maintaining traction throughout. At 90 degrees of hip flexion, traction is steadily increased and sometimes a little rotation (either internal or external) is required to accomplish reduction. Another assistant can help by applying direct medial and anterior pressure to the femoral head through the buttock. A satisfying ‘clunk’ terminates the manoeuvre. An important test follows, to assess the stability of the reduced hip. By flexing the hip to 90 degrees and applying a longitudinal and posteriorly-directed force, the hip is screened on an image-intensifier looking for signs of subluxation. Evidence of this should prompt a repair to the posterior wall of the acetabulum.
