For unilateral hip dislocation at high lumbar L1-L2, which strategy should be considered?

• A. Level the pelvis
• B. Level the head
• C. Increase hip abduction aggressively
• D. Proceed with complete immobilization of the pelvis

Answer: (A)

Pelvic alignment has a direct impact on hip stability when a unilateral dislocation occurs with a high lumbar spinal level. Pelvic obliquity from L1–L2 involvement tilts the acetabulum relative to the femoral head, increasing misalignment and dislocating forces. Leveling the pelvis rebalances weight bearing and brings the acetabulum into a better position to match the dislocated hip, reducing the driving forces of the dislocation and improving overall alignment with next steps like bracing or targeted therapy.

Leveling the head wouldn’t address the hip-pelvis mechanics driving the dislocation. Aggressive hip abduction might temporarily influence position but can create new problems such as contractures or instability and doesn’t fix the underlying obliquity. Complete immobilization of the pelvis is overly restrictive and risks skin breakdown and stiffness without solving the dislocation.