Dislocations And Fractures Of Bones pptx

Dislocations And Fractures Of Bones

1. Dislocations Dr Massam 1

2. Objectives At the end of this session, students are expected to be able to: Define dislocation Identify causes and risk factors Describe the different types of dislocations. Describe clinical features Identify the investigations Describe the management of dislocations Identify the complications of dislocations.

3. Introduction A dislocation is a total disruption of joint with no remaining contact between the articular surfaces. That is the articular surfaces are no longer in full or correct contact

4. Introduction cont.. Dislocations can be complete or partial. In a complete dislocation, the joint surfaces are completely separated. In a partial dislocation, the joint surfaces are only partly separated ( sublaxation )

5. Causes Congenital Acquired Traumatic Pathological e.g. TB hip, Septic Arthritis Paralytic e.g. Poliomyelitis, cerebral palsy, etc Inflammatory disorders, rheumatoid arthritis,etc

6. Causes :traumatic From direct Trauma High Energy trauma →Road traffic accident → Fall from Heights → Sports injuries → Industrial injuries Low Energy Trauma → Sports injuries From indirect Trauma Varus , Valgus and rotational stress

7. Types of dislocation Traumatic dislocations A force strong enough to disrupt the joint capsule and dislocates a previously normal joint . Pathological /Spontaneous dislocation Occurs when underlying pathological condition in the joint causes abnormality in the structural integrity of the joint. e.g . Septic hip dislocation

8. Types of dislocation cont .. Recurrent dislocation This is a dislocation which occurs repeatedly after trivial injuries due to weakening of the supportive joint structures Congenital dislocation A type of dislocation which is present congenitally since birth. E.g. Congenital hip dislocation

9. Types of dislocation cont.. According to the direction Anterior Anteroinferior Posterior Laxation erecta - true inferior medial/lateral

10. Common sites No joint is immune from dislocation The most commonly dislocated is the shoulder joint Elbow: Posterior dislocation, 90% of all elbow dislocations Wrist: Lunate and Perilunate dislocation most common

11. Common sites cont.. Finger : Interphalangeal ( IP) or metacarpophalangeal (MCP ) joint dislocations Hip : Posterior and anterior dislocation of hip

12. C linical features On history Deformity or abnormal appearance Pain and tenderness aggravated by movement Loss of normal function Joint may be locked in one position Swelling of the joint

13. Clinical features cont.. On Physical examination: Shoulder dislocation: Arm in a characteristic position of external rotation and slight abduction Fullness anteroinferior to the coracoid process is palpable

14. Clinical features cont.. Elbow dislocation: elbow held in flexion significant amount of soft tissue swelling around the elbow Finger dislocation: oedema and ecchymosis (bruising)

15. Clinical features cont.. Patellar dislocation swollen knee held in flexion and no obvious lateral prominence often associated with haemarthrosis (bleeding into joint spaces )

16. Clinical features cont.. Hip dislocation: Posterior hip dislocation is with the hip in a position of flexion , internal rotation, and adduction Anterior hip dislocations, the hip is classically held in external rotation, with mild flexion and abduction.

17. 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

18. Investigations X-ray of the affected part should include anterior posterior and lateral views and sometimes special views needed. CT Scan MRI

19. Principles of management Is an Emergency It should be reduced in less than 24 hours or there may be Avascular Necrosis and joint stiffness Following reduction the limb should be immobilized for several weeks.

20. Principles of management cont.. Close reduction with intravenous analgesia and sedation or under GA should be attempted first for most uncomplicated dislocation . Open reduction is rarely necessary for acute dislocation.

21. Reduction techniques Hippocrates Method ( A form of anesthesia or pain abolishing is required ) Stimpson’s technique ( some sedation and analgesia are used but No anesthesia is required ) Kocher’s technique is the method used in hospitals under general anesthesia and muscle relaxation NOTE No single best technique

22. Complications Acute : Injury to peripheral nerve and vessels Chronic : Unreduced dislocation Recurrent dislocation Traumatic osteoarthritis Joint stiffness Avascular necrosis Myositis ossificans

23. Key points 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

24. Key points cont.. 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

25. Review questions 1. What is dislocation? 2. Mention are the causes of dislocations? 3 . Describe the complications of dislocations. 28

26. References Sam W. Wiesel, John N. Delahay : Essentials of Orthopedic Surgery, Third Edition T D uckworth, C M blundell : Lecture Notes On Orthopedics And Fracture. Apley's concise system of orthopedics and fracture Medscape