Dislocation

Muhammad Shahiduzzaman

Professor & Head DepartmentOrthopaedic Surgery. DMC

Definition

It is complete and persistent displacement of a joint in which at least part of the supporting joint capsule and some of its ligaments are disrupted.

Types of dislocation Congenital Acquired1. Traumatic

2. Pathological e.g. TB hip, Septic Arthritis

3. Paralytic e.g. Poliomyelitis, cerebral palsy, etc

4. Inflammatory disorders, rheumatoid arthritis,etc

Dislocation

No joint is immune from dislocation Most commonly occur in the

following joints. Shoulder Hip Elbow Metacarpophalengeal joint Facet joint dislocation in cervical spine. Acromiclavicular joint dislocation.

Typical deformities in dislocation

Shoulder- abduction deformities Elbow- flexion deformities Hip:

Anterior- flexion abduction and internal rotation deformities.

Posterior-flexion, adduction and internal rotation deformity

Knee-flexion deformity Ankle-varus deformity

Investigations

Radiograph of the affected part should include anterior posterior and lateral views and sometimes special views needed.

CT Scan

Principles of management

Acute dislocation should be reduced as soon as possible.

Open reduction is rarely necessary for acute dislocation.

Close reduction with intravenous analgesia and sedation or under GA should be attempted first for most uncomplicated dislocation.

Complication

1. Acute: Injury to peripheral nerve and vessels

2. Chronic: Unreduced dislocationRecurrent dislocationTraumatic osteoarthritisJoint stiffnessAvascular necrosisMyositis ossificans

Caution !

Excessive force should not be used in close reduction.

Forceful manipulation may lead to fracture.

Interposition of soft tissue, bony fragment or buttonhole in capsule

may make close reduction impossible.

Remember in Dislocation

It is an orthopedic emergency. Reduction should be quick and

prompt. Reduction should always be under

G/A or sedation. Swelling is less in compared to

fractures. Movements are more restricted than

in fractures.

Remember in Dislocation

Closed reduction is sufficient in most of the times.

Open reduction is restored to if specifically indicated.

Reduction techniques should always be very gentle.

Pain will not subside by splinting unlike fractures.

Shoulder Dislocation

Types: Anterior dislocation: Varities of

dislocations like Subcoracoid, subglenoid, sub-infraclavicular, inferior.

Posterior Dislocation

Radiological ImagesAnterior Dislocation

Radiological ImagesAnterior dislocation

Occurs with the arm held in abduction and external rotation.

Radiological ImagesPosterior Dislocation

Causes1. Epilepsy2. Electrocution

Reduction Techniques

Stimson’s Gravity Method

Reduction Techniques

KOCHER’s Method

Reduction Techniques

After Treatment

The arm should be fasten to the chest with a body bandage minimum period of three weeks.

Hip Dislocation

Types:A. Posterior

DislocationB. Anterior

DislocationC. Center

Dislocation

Mechanism of Dislocation

Hip Dislocation

Clinical Features:o H/O Traumao The patient has a

flexion, adduction and medial rotational deformity of the affected limb.

o Hip movement grossly restricted.

Radiological ImagesHip dislocation

Hip DislocationReduction techniques

The patient is supine on the floor under GA.

The hip is flexed to 90 degree.

Assistant stabilizing the pelvis.

Longitudinal traction is applied.

Hip DislocationAfter Treatment

The patient is put on surface traction for three weeks.

Full weight bearing is permitted after 6 wks.

Elbow Dislocation

Commonly due to fall on outstretched hand.

Closed reduction and long arm back slab for 3 wks is the treatment of choice.

MP Joint Dislocation

IP Dislocation

Reduction Techniques..

Facet joint Dislocation

Commonest cervical spinal injury.

May lead to quadriplegia.

May be treated conservatively by Traction.

May also need Open Reduction

Thank you for your attention.