HIP and SHOULDER DISLOCATION

By:Eka W. S. C1101003Feranida C1101128Misriani C1101129

Nuraenah C1102137Willy P. C1101065Welly C1102129Indra Jaya C1100045

Supervisor:Julia dr.,

GH

Humeral art surf ( Ball )37 – 55 mm

135°

Fossa Glenoid

•Pear shaped , cartilage covered bony depression•Lined by glenoid labrum•Post tilt + 7,4°

41 mm

25 mm

75 % L60 % T

Shoulder Muscles & Action 17 muscles involved in shoulder motion

Anterior Shoulder Dislocation The most often happened Mechanism :

- Falling on hands- The humerus is pushed anteriorly- Tearing the capsel- Avultion of the Glenoid edge

Clinical sign :- Incredible pain- Patient supporting the injured side- Lateral side of shoulder is flattenned

X – Ray : AP Photo will show overlapping shadow of humerus and fossa glenoid.

Lateral Photo will show the humerus outside of the shoulder joint.

Therapy :- Traction- Kocher Method- Imobilitation of the arm - Moving of the other arm joint is obligatory

Early Complication :- Nerve Injury- Injured artery- Dislocation with Fracture

Late Complication :- Shoulder stiffness- Uncorrected dislocation- Repeated dislocation

Posterior Shoulder Dislocation 2 % of all shoulder dislocation Mechanism :

A Strong indirect force that caused internal rotation and adduction. Usually happenned after epileptic attack or after an electric shock

Clinical sign :- Often undiagnosed- Arm fixed at a medial rotation position- Flattenned shoulder with protruding korakoid (a superior view will help)

X ray :AP photo : abnormal looking of

humerus head ( like light bulb) and an empty glenoid sign.

Lateral Photo : Show subluctation or posterior dislocation

CT will helped in a difficult case Therapy :

Reduction under total anesthesia, if stable arm must be imobilized, if not keep the shoulder in wide abduction and lateral rotaion in gypsum

Complication :- Uncorrected dislocation- Recurrent dislocation and subluctation

Shoulder dislocation on kids Traumatic dislocation is very rare Usually due to daily activities wether it

happenned voluntary or involuntary Examination will show that the shoulder is

sublucsated almost to every direction Therapy :

First considered behavourial problems, then a reconstructive surgery will helped

HIP DISLOCATIONThe increased number of traffic

accident hip dislocation is more frequently happenned

Hip dislocation is classify into two groups depending on the direction of the dislocation : - Posterior- Anterior and center

Posterior DislocationFour out of five hip dislocationWhen someone in a car is thrown out

anteriorly, causing the knee to hit the dashboard.

Femur is pushed upward and the head pops out of the joint and quite often a part of the back of acetabulum is also fractured

Clinical sign :- Adducted and shortened leg- Internal rotation and a bit flexed- If a femur fractured happenned checked for a hip disloaction

X – Ray:Head of femur outside the joint cup and

over the acetabulum.The roof segment of acetabulum and the head of femur might fractured, an oblique view will show the size of the fragment. CT Scan is still the best diagnostic for fragmented femur/ acetabulum.

Epstein Classification :- Type I; Dislocation with tiny fractured fragmen- Type II; Dislocation with large fracture on the posterior lip of acetabulum- Type III; Dislocation with Comminuted of the acetabulum lip- Type IV; Dislocation with fracture on the acetabulum floor- Type V; Dislocation with fracture on the femoris head

Therapy :- Reduction ASAP under general anesthesia (Mostly closed reduction)- Imobilization of the hip with traction- Mobilization will started as soon as the pain subsided- Removal of intraarticular fragment (after the patient stabilized)- Type II; With open reduction and anatomic fixation- Type III; with closed reduction and an opened surgery to remove the fragments- Type IV & V; Closed reduction, surgery if the fragments unreducted

Early complication :- Sciaticus nerve injury- Injured Artery (Gluteal superior artery)- Fracture of the femur body

Late complication :- Avascular necrose- Miositis ossificans- Uncorrected dislocation- Osteoarthritis

Anterior Dislocation Rarely happenned Clinical Sign :

- Outer rotation, abduction and a bit flexed- A clear anterior protruded of the femur head- No hip movement

X rayAP photo usually a good diagnostic

procedure, if there’s any doubt a lateral photo will solved the problem

Therapy:Same manuver with posterior

dislocation except the thigh must be adducted when it was pulled upward

Avascular Necrosis is the only complication

Center Dislocation Falling on the side or a force on the major

trochanter will pushed the head of femur to the acetabulum floor and caused pelvic fracture

Clinical sign : Normal position with bruises and paun on the trochanter and hip, few movement canbe executed

X ray : Head of femur is moved medially and fracture of the acetabulum floor

Therapy :- Reduction and restoring the hip form- Movement must be started as soon as possible

Early Complication:Shock and viceral injury

Late complication :Stiffness of hip with or without osteoarthritis

THE END THANK YOU VERY MUCH