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Three Part Question

In [adults with acute hip dislocation] what is the effectiveness of the [Captain Morgan technique] to [easily reduce the dislocation without neuromuscular complications]?

Clinical Scenario

A 66 year old female presents to the emergency department (ED) after a motor vehicle crash. Radiographs reveal an acute posterior dislocation of the right hip. Although her hip was successfully reduced in the ED, you sustain a lumbar muscle strain while applying the necessary force to the patient's hip to accomplish reduction. The following day during a hospital conference you hear about a new method for the easy and safe management of hip dislocation called the "Captain Morgan" technique.

Search Strategy

Medline 1966-05/15 using OVID interface, Cochrane Library (2015) and Embase
[(Exp Hip Dislocation/therapy) AND (exp Manipulation, Orthopedic/methods)]. Limit to English Language.

Search Outcome

22 papers were identified, only one was relevant to the clinical question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Gregory W. Hendey MD and Arturo Avila PA-C December 2011 United States	77 hip dislocations over 4 years, identified on x-ray with at least attempted reduction in the ED. 25 encounters documented the reduction technique, 13 of these encounters used the Captain Morgan technique	Retrospective cross-sectional chart review	Successful reduction in ED without post-reduction fractures, knee injuries or neuromuscular injuries	12/13 hip reductions that used the Captain Morgan technique were successfully reduced without complication	--Study is only description of cases in which the captain morgan technique was used. No comparison of techniques or control group. --No blinding. --Many cases not able to included due to poor documentation, likely missed many cases that could have been included.

Comment(s)

A good publication to promote a potentially useful hip reduction technique. The study was very small and only a description of cases. No comparison of techniques, control group or blinding. To perform the Captain Morgan technique, the patient is supine and strapped on a backboard to help stabilize the pelvis. Keep the patient's knee and hip flexed at 90 degrees. The physician places his/her foot on the board with his/her knee behind the patient's knee. The physician holds the patient's knee in flexion by holding the ankle down and applies upward force to the hip by lifting with his/her calf while rotating the lower leg. The advantage to this technique is that it allows the physician to generate sufficient force safely, without having to stand on top of the gurney or risk straining his/her back.

Clinical Bottom Line

The Captain Morgan technique is a novel technique for reduction of hip dislocation that could be considered for reduction in the ED. However, there is no evidence showing superiority over other techniques.

References

1. Gregory W. Hendey MD and Arutho Avila PA-C The Captain Morgan Technique for the Reduction of the Dislocated Hip Annals of Emergency Medicine December 2011; 536- 540