Transcript of Acute Joint Dislocation Dr. Abdulrahman Algarni, MD, SSC (Ortho), ABOS Assist. Professor, King Saud...
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- Acute Joint Dislocation Dr. Abdulrahman Algarni, MD, SSC
(Ortho), ABOS Assist. Professor, King Saud University Consultant
Orthopedic and Arthroplasty Surgeon
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- objectives To 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
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- Acute Joint Dislocation Complete separation of the articular
surface: Joint surfaces are no longer in contact Position of distal
to proximal fragment: Anterior, Posterior, Inferior, Superior
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- Acute Joint Dislocation Usually results from high-energy trauma
They occur most frequently in young patients
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- Clinical Features Painful; 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.
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- Imaging X-rays adequate views Confirm the diagnosis Rule out
fractures i.e. a fracture- dislocation Reduce before X-rays: knee,
ankle CT scan
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- Treatment Urgent reduction: Closed; surgical if failed Adequate
pain relief; muscle relaxant; GA Imaging after reduction:
Post-reduction films Immobilization physiotherapy
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- Complications Neurovascular injury: Knee, ankle Avascular
necrosis of bone Recurrent dislocation: shoulder Heterotopic
ossification Joint stiffness Secondary osteoarthritis
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- ACUTE SHOULDER DISLOCATION The most commonly dislocating joint
shallowness of the glenoid socket and wide extraordinary range of
motion
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- ACUTE SHOULDER DISLOCATION Anterior dislocation is the most
common Posterior dislocation is rare; less than 2%
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- ANTERIOR SHOULDER DISLOCATION Fall on the outstretched hand
(abduction & external rotation)
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- ANTERIOR SHOULDER DISLOCATION The lateral outline of the
shoulder may be flattened Bulge may be felt just below the
clavicle
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- ANTERIOR SHOULDER DISLOCATION X-rays: antero-posterior and
lateral (axillary) views: Overlapping shadows of the humeral head
and glenoid fossa
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- ANTERIOR SHOULDER DISLOCATION The head usually lying below and
medial to the socket Rule out greater tubrosity fracture
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- ANTERIOR SHOULDER DISLOCATION Avulsion of the antero-inferior
glenoid labrum (Bankart lesion). Indentation of the postero-lateral
part of the humeral head (HillSachs lesion)
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- ANTERIOR SHOULDER DISLOCATION Reduction Different techniques:
Kochers, Stimsons, Milchs, Hippocratic
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- ANTERIOR SHOULDER DISLOCATION Reduction Kochers method
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- 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
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- POSTERIOR SHOULDER DISLOCATION Indirect force producing marked
internal rotation and adduction Convulsion, or with an electric
shock
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- 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
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- POSTERIOR SHOULDER DISLOCATION Imaging The 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
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- HIP DISLOCATION High energy trauma posterior (the commonest)
anterior
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- POSTERIOR HIP DISLOCATION Road Traffic accident; knee striking
against the dashboard Limb is short, adducted, internally rotated
and slightly flexed.
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- POSTERIOR HIP DISLOCATION Rule out associated fractures; femur
or acetabulum Rule out sciatic nerve injury
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- POSTERIOR HIP DISLOCATION Reduction
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- POSTERIOR HIP DISLOCATION Reduction
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- POSTERIOR HIP DISLOCATION Reduction; stable CT scan: the best
to demonstrate an acetabular fracture (or any bony fragment)
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- 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
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- ANTERIOR HIP DISLOCATION Rare compared with posterior The leg
lies externally rotated, abducted and slightly flexed Palpable head
in the groin
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- KNEE DISLOCATION High energy mechanism; RTA The cruciate
ligaments and one or both lateral ligaments are torn
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- KNEE DISLOCATION If dislocated joint has reduced spontaneously;
swelling and gross instability
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- KNEE DISLOCATION If still dislocated; gross deformity
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- KNEE DISLOCATION Repeated vascular examination is necessary;
popliteal artery injury; risk compartment syndrome Common peroneal
nerve injury: 20 % of cases
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- KNEE DISLOCATION X-ray: dislocation, fracture of the tibial
spine (cruciate ligament avulsion), avulsion of the fibular styloid
(collateral ligament avulsion)
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- KNEE DISLOCATION Angiograpy
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- KNEE DISLOCATION Urgent reduction Immediate vascular
intervention if needed Acute or delayed reconstruction of the
ligaments
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- KNEE DISLOCATION Complications Instability Stiffness
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- Summary Dislocation 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