Scribd
Upload
10 views

common dislocations (1)

Dislocations are complete joint displacements, while subluxations are incomplete. The document discusses various types of dislocations, including congenital and acquired, with a focus on shoulder, elbow, hip, and knee dislocations, their mechanisms, symptoms, diagnosis, and treatment options. Complications such as recurrence, nerve injuries, and associated fractures are also highlighted.

Uploaded by

chabsidarbi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
10 views

common dislocations (1)

Dislocations are complete joint displacements, while subluxations are incomplete. The document discusses various types of dislocations, including congenital and acquired, with a focus on shoulder, elbow, hip, and knee dislocations, their mechanisms, symptoms, diagnosis, and treatment options. Complications such as recurrence, nerve injuries, and associated fractures are also highlighted.

Uploaded by

chabsidarbi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 92

Common dislocations

Dislocations
Definition
 Dislocation is a complete displacement of the
articular surface of joint. Joints are no longer in
contact.
 Dislocations may be associated with a periarticular fracture

 Subluxation is an incomplete displacement.


 Recurrent dislocation – repeated dislocation
of a joint usually due to damage to the ligaments
and joint margin
Classification
1. Congenital
Hip dislocation , knee dislocation
2.Aquired
o Traumatic
 Dislocations are usually caused by a sudden
impact to the joint.
 This usually occurs following a blow, fall, or other
trauma
o Pathological
o Infection eg:- Tb of the joints and septic arthritis
o Paralyitic eg:-poliomyelitis, CP
o Inflammatory disorders eg:-RA
The shoulder
 ball and socket joint
very mobile and very unstable
Stabilized by rotator cuff muscles
Glenohumeral joint dislocation
Shoulder Dislocation
 Most Common dislocation seen in the ED
 Classification
oAnterior (95-98%)
• Sub coracoid,
• Sub glenoid,
• Sub clavicular
oPosterior (2-4%)
• Most commonly missed major dislocation of the
body
• Subacromial (98%), Subglenoid, Subspinous
oInferior
 Factors responsible for shoulder dislocation
The shallowness of the glenoid socket
Extraordinary ROM, highly mobile
Underlying conditions like:-
 Ligamentious laxity
 Glenoid dysplasia
Vulnerability of joint during stressful activities
of the shoulder joint
Mechanism of Injury
 Direct trauma
 Indirect trauma
o Anterior
– Abduction, Extension and External Rotation
– Direct blow from the posterior aspect of shoulder
o Posterior
– Direct blow from the anterior aspect of the shoulder
– Seizure or Electric Shock
• Fall on forward-flexed, adducted and internally
rotated arm
Signs and Symptoms
Pain
Inability to move the affected limb
Prominence of acromion process and
flattening of normal contour of the
shoulder (anterior)
Palpable globular mass
anteriorly(anterior)
Anterior flatness, posterior fullness and
prominence of the coracoid process
(posterior)
P/E
Evaluate distal NV status before and after
reduction
Dugas test
Hamilton's Ruler test
X-rays:- to confirm the diagnosis
 Standard Series = AP Shoulder + lateral or Y view
 Y view is diagnostic in posterior dislocation and without Y
view, may be missed
 Axillary view
CT scan:-to diagnose bony lesion
MRI:-to diagnose soft tissue injuries
Arthroscopy:-to evaluate rotator cuff tears
• Anterior Dislocation Posterior Displacement
– Inferior displaced humerus
AP = Internal Rotation of humerus =
“Light bulb sign”
Y view = Humeral head displaced
Treatment
1.Closed
2.Open
Closed
 Reduction using a variety of techniques
 Shoulder dislocation with associated fracture
 Make sure to evaluate vascular and nerve exam post reduction
and obtain a post-reduction film
 After reduction, patient should be placed in shoulder
immobilizer and orthopedic follow-up arranged
1.Traction counter traction
• Traction-Counter traction
2. Hippocrates method
•
Shoulder Reduction Techniques…
Stimson or Hanging Weight
Shoulder Reduction Techniques…..
6. Scapular manipulation
Shoulder Reduction Techniques…
• Scapular Manipulation

http://www.hawaii.edu/medicine/pediatrics/pemxray/v4c12.html
After reduction
Sling with chest strap
Control x ray
Complications
 Recurrence = Most common complication
o Age related (the younger the patient, the more likely of
a recurrence)
 Bony Injuries
o Hill-Sachs Deformity
 Compression fracture or groove of posterolateral
aspect of humeral head
o Avulsion of greater tuberosity (Increased in patients >
45 y/o)
o Bankart’s Fracture = Fracture of the glenoid lip
 Nerve Injuries
o May occur during dislocation or reduction
o Axillary nerve (most common) or Musculocutaneous
nerve
 Rotator Cuff Tears
Complications
• Hill Sachs Deformity • Bankart’s Fracture

http://www.mypacs.net/repos/mpv3_repo/viz/
http://www.gentili.net/signs/images/400/
full/18712/935613.jpg
shoulderhillsachs.JPG
Elbow dislocation
• Common injury in adults
• Rare in children below
10yrs of age
• Types
 Posterior(80%-90%)
 Anterior
 Medial
 Lateral
Mechanism
Posterior
o Fall on outstretched hand with arm in abduction and
extension
Anterior
o Power full blow to the posterior aspect of the elbow
 C/F
 Painful, swollen, and deformed elbow with loss of
landmarks
 Restriction of mov’t
 Elbow slightly flexed and supported by other hand
Treatment
Closed reduction
Open reduction
 If came late
Traction, flexion, and direct manual push
Hip Anatomy
 Hip joint is inherently stable due to
Bony anatomy
Soft tissue constraints including
 Labrum
 Capsule
 Ligamenteum terse
 muscles
• Hip dislocation
Two types
Posterior hip disl.(90%)
Anterior hip dis (<10%)
Central
Mechanism:-
Almost always due to high-energy trauma.
Most commonly involve unrestrained occupants in
MVAs/RTAs.
Can also occur in pedestrian-MVAs/RTAs, falls from
heights, industrial accidents and sporting injuries.
Posterior Hip Dislocation (80-90%)
o Mechanism of Injury
 Majority are due to auto-accidents with direct force
applied to flexed knee(impact of dashboord over the
knee), pushing femoral head through the posterior
capsule
o Clinical Features
Shortened, Adducted and Internally Rotated
Associated Physical Findings
– Acetabular or Femoral Fractures
– Sciatic Nerve Injury
– Knee Injury
Physical Examination: Classical Appearance
Physical Examination: Classical Appearance

Posterior Dislocation: Hip flexed, internally


rotated, adducted.
Anterior Hip Dislocation (10%)
o Mechanism of Injury
 Extreme abduction pushes femoral head out
through tear in anterior capsule from auto
accident or fall
o Clinical Features
 abduction, external rotation
Associated vascular injuries with diminished
femoral or distal pulses indicates need for
immediate reduction
Physical Examination: Classical Appearance

Anterior Dislocation: Extreme external


rotation,
less-pronounced
abduction
P/E
 Pain to palpation of hip.
 Pain with attempted motion of hip.
 Possible neurological impairment
Investigation
 X-ray
 CT scan
Treatment
– Early reduction to avoid Avascular necrosis of the femoral
head
– Closed Reduction should be attempted in ED
– Commonly with SA or GA
– operative repair if unsuccessful
Bigelow reduction
 How to know reduced hip
Limb moves more freely
Pt more comfortable
• Post successful reduction, take
– X-ray
– CT scan
• For simple dislocation and congruent and
stable hip after reduction despite small
fragments- the non operative method
becomes definitive
• Just protected weight bearing for some time
• After reduction
– hip extended and externally rotated
– knee immobilizer/traction in abduction position
Complications
– Anterior dislocation = Femoral Artery, vein, nerve injury
– Posterior dislocation = Sciatic Nerve injury
– AVN
– Secondary OA
Indication for open reduction

1. Irreducible hip dislocation


2. Hip dislocation with femoral neck
fracture
3. Incarcerated fragment in joint
4. Incongruent reduction
5. Unstable hip after reduction
Knee dislocation
• Rare injury caused by a
high energy trauma
• Associated injuries are
common
• C/F
 Knee is swollen, grossly
deformed and bruised
• Rx
 Urgent reduction under GA
 Posterior Splint with cast
 Rx of associated injury
Thank you

You might also like