Joint DislocationsRichard Hay
with minor assistance from James Wheeler
Shoulder Dislocations
Types of Dislocation
• Anterior - subcoracoid (60%)
Types of Dislocation
• Anterior - subcoracoid (60%)• Anteroinferior - subglenoid (30%)
Types of Dislocation
• Anterior - subcoracoid (60%)• Anteroinferior - subglenoid (30%)• Posterior (4-10%)
Types of Dislocation
• Anterior - subcoracoid (60%)• Anteroinferior - subglenoid (30%)• Posterior (4-10%)• Laxation erecta - true inferior
Luxatio Erecta inferior glenohumeral dislocation
Shoulder reduction techniques
General Principles
• Relocation prevented by• Static forces• Joint capsule / lip of glenoid
• Dynamic forces• Rotator cuff• Biceps• Trapezius / deltoid• Pectoralis
General Principles
• Alignment• Scapula and humeral head• Zero position• combination of external rotation and
abduction• Relaxation
Reduction techniques• No single best technique• Hippocratic• Kocher’s• Matsen’s traction countertraction• Milch • Stimson’s • Scapular rotation• Cunningham• Spaso• Mane’s• Self rescue (Boss-Holzach-Matter)
Hip Dislocation
Types of Dislocation• Posterior (90%)• Axial load in flexed adducted hip• Position• Flexion / adduction / internal rotation
• Anterior• Load on abducted externally rotated hip• Hip in extension - superior
• XR - larger femoral head / lesser trochanter more visible
• Hip in flexion - inferior• Position• Flexion / abduction / external rotation
• Case courtesy of Dr Sajoscha Sorrentino, Radiopaedia.org, rID: 14836
• Case courtesy of Dr Sajoscha Sorrentino, Radiopaedia.org, rID: 14836
Reduction• Within 6hrs• Patient supine• Adequate sedation• Posterior dislocation• Stabilise pelvis• Axial traction• Flex hip to 90 deg flexion, external rotation, extension and abduction
• Anterior dislocation• Axial traction• Flex hip and knee to 90 deg, internal rotation, extension and adduction
• CT post reduction
Ankle dislocations
Knee dislocation• Use position of tibia as reference• Anterior (most common)• Hyperextension
• Posterior• Force to anterior tibia with knee flexed
• Medial / lateral / rotational• Valgus / varus / rotational forces
Elbow dislocation• 2nd most common large jt dislocation• Simple / complex• Radial head #• Coronoid #
• Terrible triad
Knee dislocation
• High force injury• Associated injuries