To save time, I had elected to do the reduction with the patient still on the gurney. Tom, the scrub tech, Carole, the circulating nurse, and I lowered the gurney as far as it would go, locked the wheels, and put down the side rails, removing all of Jeff’s pillows.
Standing on two stacked lifts for leverage, I cradled Jeff’s leg in my arms, rocking it just slightly, visualizing how the femur pivoted on its attachments. I needed to move it in the reverse direction of the path it had taken out of the socket. Carole stood on Jeff’s left, leaning on his pelvis with both hands solidly planted to stabilize it. I asked Tom, a muscular six-footer, to brace Jeff’s pelvis with his right hand and place his left hand on the inside of the injured thigh. “Ready?” I asked my team.
Then, using Jeff’s leg as a handle, I slowly began to pull, with my trunk more than my arms, along the axis of his thigh. I felt the leg elongate, then stop. Then I rotated it outward just a bit, unlocking the dislocation. “Give me some lateral pressure, Tom,” I directed, and as he pushed outward, I rolled Jeff’s thigh inward, keeping the traction strong and steady.
I felt—and we all heard—a satisfactory clunk. Cautiously, I moved Jeff’s hip through a full range of motion to test its stability. “Is X-ray here yet?” I asked, gently laying his leg down on the gurney. It had been less than four hours since the accident.
The X-rays showed a perfect match between the right and the left hips, reassuring me that I would see no stray bone chips on a postreduction CT scan. We transferred Jeff to a hospital bed before he was awake, applying light traction to his right leg through a foam-and-Velcro boot. In the recovery room, he groggily said he felt fine, and the next morning his nurse told me he had slept all night.
Jeff’s mother, an elegantly dressed woman, sat by his bed as I entered the room. “Thank you so much for taking care of Jeff,” she said, rising to take my hand. “He’s feeling really good. In fact, he was wondering when you were going to let him out of here so he can go check on his motorcycle.” Her attempt at a smile came off as a grimace. “I’d thought his injury was more serious than that.”
“He was very lucky,” I began. “Lucky to have no other injuries, lucky he had a simple dislocation and not a fracture-dislocation, lucky that we were able to get him into the operating room without delay, lucky that the joint reduced so easily. If we see no other damage on his scan, then he really does have the best possible prognosis after a hip dislocation. But he’s not out of the woods.”
Mother and son looked at each other.
“Even if he doesn’t develop avascular necrosis over the next two years, his hip has a higher chance of becoming arthritic earlier in life than if this hadn’t happened,” I added. ”There’s nothing we can really do to prevent it. For now, I’m going to keep him in bed for a couple of days and then begin physical therapy, to keep him from getting weak and stiff.
He’ll probably go home in four or five days, but he’ll need to walk without putting full weight on that hip for at least a month. After that, it depends on how he’s feeling and how his X-rays look. He may have to go back on crutches if we see changes in the femoral head.”
Jeff looked upset. “I guess I won’t be able to work anytime soon,” he said. “They don’t have light duty at the body shop.”
“If you ever wanted to learn another line of work, this might be the year,” I said. “Most people don’t do the same thing their whole lives these days, anyway.”
As the months passed, Jeff showed no signs of avascular necrosis, and after nearly a year of follow-up I was ready to release him to go back to work. By then, he was halfway through an associate’s degree in computer science and had decided to finish it. The last I heard from him was a short thank-you note on the stationery of a software-engineering firm. Enclosed was a picture of himself on a big new sky blue BMW motorcycle.