Hip Dislocation in Doomsday

A little over two months ago, I ran an article on managing
shoulder dislocations when there is no doctor, and at that time regular reader
Exile1981 asked if I had an info on dealing with hip dislocations, as he had
experienced it once. 

Fortunately, four of the off-grid medicine references on my
shelf here address the issue. 

Hip dislocation most often occurs in someone who has had a
hip joint replacement.[1]  A fall, a blow to the thigh, or direct force
to the foot or knee may cause dislocation of the hip, and at the same time, a
fracture may also occur as a result of the tremendous forces that caused this
dislocation.[2]  Comparison of the injured side with the
unaffected side will reveal a marked deformity.[3]

TREATMENT

The Ship’s Medicine
Chest states the following about treatment:

No attempt should be made to reduce
a dislocation of the hip.  The injury is
serious and should be treated only by a physician.  The patient should be transported on a long
spine board.  A blanket, pillow, or other
suitable padding should be used to support the legs in the position of the
deformity.  This position should be
maintained after the patient has been transferred to a bed in his quarters or
the sickbay. 

For pain, aspirin 600 mg with
codeine sulfate 30 mg should be given by mouth. 
If aspirin is not well tolerated by the patient, acetaminophen may be
tried at the same dosage and frequency. 
Before repeating the codeine sulfate, medical advice by radio should be
obtained.[4]

However, in austere circumstances such as the challenging
times ahead may present, we need to be prepared with the supplies a medical
professional will need to administer treatment. 
Part of this preparation includes understanding how the hip dislocation
may be treated.

First off, the dislocation must be reduced (doctor-speak for
putting the bone back into its proper place) ASAP.  Not only will this decrease the pain and
lessen damage to blood vessels and nerves, it will also reduce the likelihood
of permanent damage.  And, just as
importantly, it will be easier to do before the muscles spasm and everything
swells.[5] 

Be advised that this is a painful procedure.  Ibuprofen may help.  Dr. Alton notes that a muscle relaxer,
cyclobenzaprine (Flexeril), would be nice; however, it is available by
prescription only in the US.  All Day Chemist does
not sell it, but it is available through Buy-Pharma.md.  Survival
and Austere Medicine, 3^rd Edition states that reduction usually
requires deep sedation or anesthesia.[6]

To perform the reduction:

Position the patient on the floor.  “Their hip should be bent perpendicular to
the floor and knee flexed.  An assistant
should stabilize the pelvis and prevent it moving.  Traction (pulling the dislocated bone away
from the joint to create room for the bone to slip back into place[7]) towards the ceiling
should then be applied along the length of the thigh.  Reduction is generally confirmed by a loud ‘clunk’
and a return to normal length with relative pain-free further hip movements.”[8]

Dr. Alton clarifies this a bit:

1. Stabilize the joint that the bone was dislocated from by
holding it firmly. 

2.  Use a firm but slow
pulling action to pull the bone away from the joint.  This will make space for the bone to realign.

3.  Use your other
hand (or better, an assistant’s hands) to push the dislocated portion of the
bone so that it will be in line again with the joint socket.  The bone will naturally want to revert to its
normal position in the joint.

After the hip has been reduced, the pelvis must be
stabilized so that the hip does not slip out again, for at least one
month.  Forceful use of the limb must be completely
avoided for several months.[9]

Even with quick treatment, there has probably been some
lasting damage and the dislocation may have a tendency to reoccur.[10]

Links to related
posts:

Ankle Dislocation in Armageddon  

Dealing with Shoulder Dislocation in Doomsday

Another Source for Hard-to-Get Medications—Buy-Pharma.md