CSS Dislocation
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Transcript of CSS Dislocation
POSTERIOR DISLOCATION
• Usually in a car accident in a truck or car is thrown forward – strikingknee against dashboard
• Mostly in a driver worker, taxy driver etc
POSTERIOR DISLOCATION
• Clinical Features:• the leg is short and lies adducted,
• internally rotated and
• slightly flexed.
The golden rule is to x-ray the pelvis in every case of severe injury
and, with femoral fractures, to insist on an x-ray that includes both
the hip and knee.
Treatment
• The dislocation must be reduced as soon as possible under
general anaesthesia.
• In the vast majority of cases this is performed closed, but if this
is not achieved after two or three attempts an open reduction is
required.
Treatment
• by applying traction in the line of the femur as it lies (usually in
adduction and internal rotation),
• and then gradually flexes the patient’s hip and knee to 90 degrees,
maintaining traction throughout.
• At 90 degrees of hip flexion, traction is steadily increased and
sometimes a little rotation (either internal or external) is required to
accomplish reduction
• Another assistant can help by applying direct medial and anterior
pressure to the femoral head through the buttock
Complication
• EARLYSciatic nerve injuryVascular injuryAssociated fractured femoral shaft• LATEAvascular necrosis= 10% of trauma hip. If
reduction delay than 12 hours the figure rises to 40%. Myositis ossificansUnreduced dislocationOsteoartrhitis.
Prognosis
• if the reduction was per- formed promptly (within 6 hours), then
no more than 6 weeks should suffice,
• but if there was a longer delay then an extended period of 12
weeks may be wiser.
Anterior dislocation
• nowadays the usual cause is a road accident or air crash
Clinical Features
• The leg lies externally rotated, abducted and slightly flexed.
• Seen from the side, the anterior bulge of the dislocated head is
unmistakable, especially when the head has moved anteriorly
and superiorly.
Central Dislocation
• A fall on the side, or a blow over the greater trochanter, may
force the femoral head medially
• through the floor of the acetabulum. Although this is called
‘central dislocation’, it is really a fracture of the acetabulum
Dislocation of knee
• Clinical Features1. Rupture of the joint capsule produces a leak of the
haemarthrosis, leading to severe bruising and swelling.
2. the diagnosis is straightforward as there is gross defor- mity
3. The circulation in the foot must be examined because the
popliteal artery may be torn or obstructed.
Dislocation of knee
• Clinical Features1. the films occasionally reveal a fracture of the tibial spine or
posterior part of the plateau (cruciate ligament avulsion),
2. avulsion of the fibular styloid or avulsion of a fragment from
the near the edge of the lateral tibial condyle (the Segond
fracture).
Treatment
• Reduction under anaesthesia is urgent
• this is usually achieved by pulling directly in the line of the
leg,
• but hyperextension must be avoided because of the dan-
ger to the popliteal vessels.
• the limb is rested on a back-splint and the circulation is
checked repeatedly during the 48 hours.
Dislocation of Patella
• If the dislocation has reduced spontaneously, the knee may be swollen and there may be bruising and tenderness on the medial side.
• If the dislocation has reduced spontaneously, the knee may be swollen and there may be bruising and tenderness on the medial side.
IMAGING
• Anteroposterior, lateral and tangential (‘skyline’) x-ray views are needed.
• MRI may reveal a soft-tissue lesion (e.g. disruption of the medial patellofemoral ligament) as well as artic- ular cartilage and/or bone damage.
TREATMENT
• In most cases the patella can be pushed back into place without much difficulty and anaesthesia is not always necessary
• the exception is an intra-articular (intercondylar) dislocation, which may need open reduction.
• If there are no signs of soft tissue rupture – i.e. there is minimal swelling, no bruising and little ten- derness – cast splintage alone will usually suffice.
TREATMENT
• The cast is retained for 2 or 3 weeks and the patient then undergoes a long period (2–3 months) of quadriceps strengthening exercises.
PERONEAL DISLOCATION
• Acute dislocation of the peroneal tendons may accom- pany – or may be mistaken for – a lateral ligament strain.
• Recurrent subluxation or dislocation is unmistak- able; the patient can demonstrate that the peroneal tendons dislocate forwards over the fibula during dor- siflexion and eversion.
PERONEAL DISLOCATION
• Treatment in a below- knee cast for 6 weeks will help in a proportion of cases; the remainder will complain of residual symptoms.