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
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
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
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
