A nurse is caring for a client who sustained a posterior hip dislocation following a motor vehicle accident. The client reports severe pain and inability to move the affected leg, which appears shortened and internally rotated. Which nursing intervention should be the priority?
The client reports severe pain and inability to move the affected leg, which appears shortened and internally rotated.
1Apply ice packs to the affected hip area to reduce swelling
2Administer prescribed pain medication immediately for relief
3Encourage early ambulation to prevent complications such as DVT
4Maintain the client in supine position and immobilize the affected leg✓ 정답
해설
Immediate immobilization in supine position is priority for posterior hip dislocation to prevent further injury and complications like avascular necrosis or sciatic nerve damage. Other interventions such as ice or pain medication are secondary.
Understanding Posterior Hip Dislocation
A posterior hip dislocation occurs when the femoral head is forced out of the acetabulum backward, often due to high-energy trauma such as a motor vehicle accident. The affected leg typically presents in a shortened, adducted, and internally rotated position. The immediate priority is to prevent further injury to the surrounding neurovascular structures, particularly the sciatic nerve, and to maintain the joint's alignment until definitive reduction can be performed.
Analyzing the Priority Intervention
The primary goal in the initial management of a joint dislocation is immobilization to prevent damage to the joint capsule, blood vessels, and nerves. Movement of the dislocated hip can cause a fragment of the posterior acetabular wall to displace further, as posterior wall fractures are a common associated injury in this mechanism [2]. Therefore, the priority nursing action is to stabilize the limb in its presenting position of comfort, which is typically the path of least tension on the surrounding soft tissues.
Evaluating the Options
- Option 1: Apply ice packs. While ice is a valuable intervention for pain and edema, it does not address the immediate risk of neurovascular compromise or further musculoskeletal injury caused by an unstable joint. It is an important comfort measure but is not the priority.
- Option 2: Encourage early ambulation. This is contraindicated before the hip joint is reduced and stabilized. Weight-bearing or movement on a dislocated joint will exacerbate soft tissue injury, increase the risk of sciatic nerve palsy, and may convert a simple dislocation into a complex one with an associated fracture.
- Option 3: Position supine with legs extended. For a posterior hip dislocation, the client will not be able to extend the leg due to muscle spasm and the mechanical block of the femoral head behind the acetabulum. Forcing the leg into extension would cause severe pain and potential iatrogenic injury, a risk highlighted by the significant force sometimes required even in controlled reduction techniques [1].
- Option 4: Maintain position of comfort and immobilize. This is the correct priority. By supporting the limb in its naturally assumed, deformed position, the nurse minimizes movement at the fracture or dislocation site. This action directly protects the neurovascular bundle and prevents the development of complications such as post-traumatic osteoarthritis, which is strongly linked to the severity of the initial articular injury and the presence of intra-articular fragments [2]. Immobilization is the critical first step before diagnostic imaging and definitive closed or open reduction, which may require adequate sedation and muscle relaxation to be performed safely [1].
References (research sources)
[1]
The Hana Table Can Be Used for Successful and Safe Closed Reduction of Anterior and Posterior Total Hip Dislocations, Even in Prolonged Dislocation up to 36 Hours.Research articleJassal A, Princesa C, Mai K. (2026) · DOI: 10.1016/j.artd.2026.101974
[2]
Risk factors for post-traumatic osteoarthritis following surgical treatment of acetabular posterior wall fractures: a retrospective study.Research articleYuan G, Ke X, Lian J, Wang G, Lan SH, Liu XM. (2026) · DOI: 10.1038/s41598-026-41893-6
Clinical Practice Guide: Posterior Hip Dislocation
Immediate Nursing Priority
The primary intervention is to maintain the client in a supine position and immobilize the affected leg in its presenting position (shortened, internally rotated). Do not attempt to reposition or straighten the limb. This prevents further shearing injury to the articular cartilage, sciatic nerve, and femoral head vasculature before emergency reduction.
Key Assessment Findings
Severe hip pain with inability to move the leg
Affected leg appears shortened and internally rotated (classic sign for posterior dislocation)
Conduct a thorough neurovascular assessment: check pedal pulses, capillary refill, sensation, and motor function (specifically dorsiflexion/plantarflexion for sciatic nerve integrity)
Monitor for signs of sciatic nerve injury: foot drop, numbness over the lateral leg and foot
Contraindicated Actions
Do not encourage ambulation or any active/passive range of motion of the hip
Do not apply traction or attempt to reduce the dislocation; this is a provider-performed procedure
Do not delay provider notification for comfort measures like ice application or pain medication, though these can be provided concurrently once the limb is stabilized
Rationale for Urgency
A posterior hip dislocation is an orthopedic emergency. The displaced femoral head compromises blood flow to the bone, with the risk of avascular necrosis increasing significantly after 6 hours. It also places direct pressure on the sciatic nerve. Prompt reduction (ideally within 6 hours) is critical to preserve joint function and prevent permanent disability.
Posterior Hip Dislocation — Orthopedic emergency where the femoral head is displaced posteriorly out of the acetabulum, classically presenting with a shortened, internally rotated leg.
Avascular Necrosis (AVN) — Death of bone tissue due to a lack of blood supply; a major complication of hip dislocation if the femoral head's blood flow is not quickly restored by reduction.
Sciatic Nerve Injury — A common complication of posterior hip dislocation due to the nerve's proximity to the hip joint, potentially causing motor weakness (foot drop) and sensory loss.
Closed Reduction — A nonsurgical procedure where a provider manually manipulates the dislocated femoral head back into the acetabulum, ideally performed emergently.