Conscious sedation versus rapid sequence intubation for the reduction of native traumatic hip dislocation

Aravind K Bommiasamy; Dayton Opel; Raluca McCallum; John D Yonge; Vicente Undurraga Perl; Christopher R Connelly; Darin Friess; Martin A Schreiber; Richard J Mullins

doi:10.1016/j.amjsurg.2018.02.023

Conscious sedation versus rapid sequence intubation for the reduction of native traumatic hip dislocation

Am J Surg. 2018 Nov;216(5):869-873. doi: 10.1016/j.amjsurg.2018.02.023. Epub 2018 Feb 27.

Authors

Aravind K Bommiasamy¹, Dayton Opel², Raluca McCallum³, John D Yonge³, Vicente Undurraga Perl³, Christopher R Connelly³, Darin Friess², Martin A Schreiber³, Richard J Mullins³

Affiliations

¹ Department of Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Mail Code: L223, Portland, OR, 97239, USA. Electronic address: bommiasa@ohsu.edu.
² Department of Orthopedics and Rehabilitation, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Sam Jackson Hall Suite 2360, Portland, OR, 97239, USA.
³ Department of Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Mail Code: L223, Portland, OR, 97239, USA.

PMID: 29534815
DOI: 10.1016/j.amjsurg.2018.02.023

Abstract

Background: Traumatic hip dislocations (THD) are a medical emergency. There is debate whether the painful reduction of a dislocated hip should be first attempted using primary conscious sedation (PCS) or primary general anesthesia (PGA) METHODS: All cases of native THD from 2006 to 2015 in the trauma registry of a level 1 trauma center were reviewed. The primary outcome was successful reduction of the THD.

Results: 67 patients had a native, meaning not a hip prosthesis, THD. 34 (50.7%) patients had successful PCS, 12 (17.9%) failed PCS and underwent reduction following PGA. 21 (31.3%) underwent PGA. Patients in the PGA group were more severely injured. Time to reduction greater than 6 h was associated with PCS failure (Odds ratio (95% confidence interval) 19.75 (2.06,189.10) p = 0.01).

Conclusion: Clinicians treating patients with a THD can utilize either PCS or PGA with many patients safely reduced under PCS. However, patients whose hip have been dislocated for more than 6 h are at risk for failure with PCS, and are good candidates for PGA.

Keywords: Acute care; Anesthesia; Hip dislocation; Sedation; Trauma.

MeSH terms

Adult
Arthroplasty, Replacement, Hip / methods*
Conscious Sedation / methods*
Emergency Service, Hospital*
Female
Follow-Up Studies
Hip Dislocation / etiology
Hip Dislocation / surgery*
Hip Injuries / complications*
Hip Injuries / surgery
Humans
Intubation, Intratracheal / methods*
Male
Retrospective Studies