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, 3rd 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
[1] Survival and Austere Medicine, 3rd Edition, 2017, 178.
[2] The Ship’s Medicine Chest and Medical Aid at Sea, 1978, 88.
[3] The Ship’s Medicine Chest and Medical Aid at Sea, 1978, 88.
[4] The Ship’s Medicine Chest and Medical Aid at Sea, 1978, 88.
[5] Dr. Joseph Alton, The Survival Medicine Handbook, 2013, 352.
[6] Survival and Austere Medicine, 3rd Edition, 2017, 178.
[7] Dr. Joseph Alton, The Survival Medicine Handbook, 2013, 352.
[8] Survival and Austere Medicine, 3rd Edition, 2017, 178.
[9] David Werner, Where There Is No Doctor, 1992, 101.
[10] Dr. Joseph Alton, The Survival Medicine Handbook, 2013, 352.
Hip dislocation involving a prosthesis...a metal hip is a simple straightforward situation. You pull it back in plsce. Easier said than done and I have seen experienced orthopedists have difficulty doing it. A dislocation in a live bone hip frequently results in Avascular Necrosis. Death of the bone. The only treatment for this is a prosthetic hip. The best treatment is prevention. Be careful if prope medical care is not available. A dislocated joint must be reduced. The sooner the better. It's a very painful thing but an absolute necessity.
ReplyDeleteThanks for your comments on this article and others. I really appreciate them.
DeleteI just got home tonight and this was the article. Thanks very much. Mine was from coming out the doorand not realizing we had had freezing rain overnight. I went down the stairs, down the walk and slammed the one leg into the curb or something I temember lots of painkillers and the pop when the put it back in. I dont remember much more of it. I must have been 10 or so. I dont remember having to immobilize it for a month but kids bounce back easier.
ReplyDeleteThese days i have stiffness and when it gets bad i do these stretches my current doc showed me and it pops and the pain goes away. She said when it gets bad to lie on my side vad hip up and bent my knee so my foot is touching my butt and use my hand to pull the foot towards my hip.
Exile1981
Quite the experience to have as a boy. Sure hope you never have a repeat.
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