dislocation
DESCRIPTION
Undergraduate lecture class by renowned Professor of Orthopaedics, Prof. Muhammad Shahiduzzaman.TRANSCRIPT
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Dislocation
Muhammad Shahiduzzaman
Professor & Head DepartmentOrthopaedic Surgery. DMC
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Definition
It is complete and persistent displacement of a joint in which at least part of the supporting joint capsule and some of its ligaments are disrupted.
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Types of dislocation Congenital Acquired1. Traumatic
2. Pathological e.g. TB hip, Septic Arthritis
3. Paralytic e.g. Poliomyelitis, cerebral palsy, etc
4. Inflammatory disorders, rheumatoid arthritis,etc
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Dislocation
No joint is immune from dislocation Most commonly occur in the
following joints. Shoulder Hip Elbow Metacarpophalengeal joint Facet joint dislocation in cervical spine. Acromiclavicular joint dislocation.
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Typical deformities in dislocation
Shoulder- abduction deformities Elbow- flexion deformities Hip:
Anterior- flexion abduction and internal rotation deformities.
Posterior-flexion, adduction and internal rotation deformity
Knee-flexion deformity Ankle-varus deformity
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Investigations
Radiograph of the affected part should include anterior posterior and lateral views and sometimes special views needed.
CT Scan
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Principles of management
Acute dislocation should be reduced as soon as possible.
Open reduction is rarely necessary for acute dislocation.
Close reduction with intravenous analgesia and sedation or under GA should be attempted first for most uncomplicated dislocation.
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Complication
1. Acute: Injury to peripheral nerve and vessels
2. Chronic: Unreduced dislocationRecurrent dislocationTraumatic osteoarthritisJoint stiffnessAvascular necrosisMyositis ossificans
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Caution !
Excessive force should not be used in close reduction.
Forceful manipulation may lead to fracture.
Interposition of soft tissue, bony fragment or buttonhole in capsule
may make close reduction impossible.
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Remember in Dislocation
It is an orthopedic emergency. Reduction should be quick and
prompt. Reduction should always be under
G/A or sedation. Swelling is less in compared to
fractures. Movements are more restricted than
in fractures.
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Remember in Dislocation
Closed reduction is sufficient in most of the times.
Open reduction is restored to if specifically indicated.
Reduction techniques should always be very gentle.
Pain will not subside by splinting unlike fractures.
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Shoulder Dislocation
Types: Anterior dislocation: Varities of
dislocations like Subcoracoid, subglenoid, sub-infraclavicular, inferior.
Posterior Dislocation
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Radiological ImagesAnterior Dislocation
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Radiological ImagesAnterior dislocation
Occurs with the arm held in abduction and external rotation.
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Radiological ImagesPosterior Dislocation
Causes1. Epilepsy2. Electrocution
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Reduction Techniques
Stimson’s Gravity Method
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Reduction Techniques
KOCHER’s Method
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Reduction Techniques
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After Treatment
The arm should be fasten to the chest with a body bandage minimum period of three weeks.
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Hip Dislocation
Types:A. Posterior
DislocationB. Anterior
DislocationC. Center
Dislocation
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Mechanism of Dislocation
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Hip Dislocation
Clinical Features:o H/O Traumao The patient has a
flexion, adduction and medial rotational deformity of the affected limb.
o Hip movement grossly restricted.
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Radiological ImagesHip dislocation
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Hip DislocationReduction techniques
The patient is supine on the floor under GA.
The hip is flexed to 90 degree.
Assistant stabilizing the pelvis.
Longitudinal traction is applied.
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Hip DislocationAfter Treatment
The patient is put on surface traction for three weeks.
Full weight bearing is permitted after 6 wks.
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Elbow Dislocation
Commonly due to fall on outstretched hand.
Closed reduction and long arm back slab for 3 wks is the treatment of choice.
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MP Joint Dislocation
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IP Dislocation
Reduction Techniques..
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Facet joint Dislocation
Commonest cervical spinal injury.
May lead to quadriplegia.
May be treated conservatively by Traction.
May also need Open Reduction
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Thank you for your attention.