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Acute Joint Dislocation. Dr. Abdulrahman Algarni , MD, SSC (Ortho), ABOS Assist. Professor, King Saud University Consultant Orthopedic and Arthroplasty Surgeon. objectives. To know mechanisms of the most common joint dislocations Be able to make the diagnosis - PowerPoint PPT Presentation
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Acute Joint Dislocation
Dr. Abdulrahman Algarni, MD, SSC (Ortho), ABOSAssist. Professor, King Saud University
Consultant Orthopedic and Arthroplasty Surgeon
objectivesTo know mechanisms of the most common
joint dislocations
Be able to make the diagnosis
To know and interpret the appropriate x-rays
To know the common complications and how to avoid them
Acute Joint DislocationComplete separation of the
articular surface: Joint surfaces are no longer in contact
Position of distal to proximal fragment: Anterior, Posterior, Inferior, Superior
Acute Joint DislocationUsually results from
high-energy trauma
They occur most frequently in young patients
Clinical FeaturesPainful; inability to move the limb
Abnormal shape of the joint
The limb is often held in a characteristic position
Careful NV exam before reduction is attempted.
ImagingX-rays
adequate views
Confirm the diagnosis
Rule out fractures i.e. a fracture-dislocation
Reduce before X-rays: knee, ankle
CT scan
Treatment
Urgent reduction: Closed; surgical if failed
Adequate pain relief; muscle relaxant; GA
Imaging after reduction: Post-reduction films
Immobilization
physiotherapy
Complications
• Neurovascular injury: Knee, ankle
• Avascular necrosis of bone
• Recurrent dislocation: shoulder
• Heterotopic ossification
• Joint stiffness
• Secondary osteoarthritis
ACUTE SHOULDER DISLOCATION
• The most commonly dislocating joint
• shallowness of the glenoid socket and wide extraordinary range of motion
ACUTE SHOULDER DISLOCATION
• Anterior dislocation is the most common
• Posterior dislocation is rare; less than 2%
ANTERIOR SHOULDER DISLOCATION
Fall on the outstretched hand (abduction & external rotation)
ANTERIOR SHOULDER DISLOCATION
• The lateral outline of the shoulder may be flattened
• Bulge may be felt just below the clavicle
ANTERIOR SHOULDER DISLOCATION
• X-rays: antero-posterior and lateral (axillary) views:
• Overlapping shadows of the humeral head and glenoid fossa
ANTERIOR SHOULDER DISLOCATION
The head usually lying below and medial to the socket
Rule out greater tubrosity fracture
ANTERIOR SHOULDER DISLOCATION
Avulsion of the antero-inferior glenoid labrum (Bankart lesion).
Indentation of the postero-lateral part of the humeral head (Hill–Sachs lesion)
ANTERIOR SHOULDER DISLOCATION
Reduction
Different techniques: Kocher’s, Stimson’s, Milch’s, Hippocratic
ANTERIOR SHOULDER DISLOCATION
Reduction
Kocher’s method
ANTERIOR SHOULDER DISLOCATION
Complications Recurrent dislocation: age at first dislocation
Rotator cuff tear: elderly
Axillary nerve injury; neuropraxia
Axillary artery injury
Shoulder stiffness: prolonged immobilization
Unreduced (undiagnosed) dislocation
POSTERIOR SHOULDER DISLOCATION
Indirect force producing marked internal rotation and adduction
Convulsion, or with an electric shock
POSTERIOR SHOULDER DISLOCATION
The diagnosis is frequently missed; more than 50%
The arm is held in internal rotation and is locked in that position
The front of the shoulder looks flat with a prominent coracoid
POSTERIOR SHOULDER DISLOCATIONImagingThe humeral head is medially
rotated (electric light bulb)
(The empty glenoid sign)
Axillary or Scapular view is essential
Rule out fractures; neck, glenoid or lesser tuberosity
CT
HIP DISLOCATION
High energy trauma
posterior (the commonest)
anterior
POSTERIOR HIP DISLOCATION
Road Traffic accident; knee striking against the dashboard
Limb is short, adducted, internally rotated and slightly flexed.
POSTERIOR HIP DISLOCATION
Rule out associated fractures;
femur or acetabulum
Rule out sciatic nerve injury
POSTERIOR HIP DISLOCATIONReduction
POSTERIOR HIP DISLOCATIONReduction
POSTERIOR HIP DISLOCATIONReduction; stable
CT scan: the best to demonstrate an acetabular fracture (or any bony fragment)
POSTERIOR HIP DISLOCATION
Sciatic nerve injury; 10%
Avascular necrosis of the femoral head ;10%
If reduction is delayed by more than 12 hours, it rises to over 40%
Hetrotopic ossification
ANTERIOR HIP DISLOCATION
Rare compared with posterior
The leg lies externally rotated, abducted and slightly flexed
Palpable head in the groin
KNEE DISLOCATION
High energy mechanism; RTA
The cruciate ligaments and one or both lateral ligaments are torn
KNEE DISLOCATIONIf dislocated joint has reduced spontaneously; swelling and
gross instability
KNEE DISLOCATION
If still dislocated; gross deformity
KNEE DISLOCATION
Repeated vascular examination is necessary; popliteal artery injury; risk compartment syndrome
Common peroneal nerve injury: 20 % of cases
KNEE DISLOCATION
X-ray: dislocation, fracture of the tibial spine (cruciate ligament avulsion), avulsion of the fibular styloid (collateral ligament avulsion)
KNEE DISLOCATION
Angiograpy
KNEE DISLOCATION
Urgent reduction
Immediate vascular intervention if needed
Acute or delayed reconstruction of the ligaments
KNEE DISLOCATION
Complications
Instability
Stiffness
SummaryDislocation is an orthopedic emergency and
need urgent reduction
Anterior shoulder dislocation is the commonest
Obtain adequate imaging to rule out posterior shoulder dislocation
Acute unstable knee is a knee dislocation until proven otherwise
Always suspect vascular injuries with dislocated knee