management of shoulder and hip dislocation.pptx

shoulder & hip dislocation

1. MAJOR JOINT DISLOCATIONS – HIP , SHOULDER & KNEE

2. 3 true orthopaedics emergencies Dislocation Fracture associated with limb threatening vascular injury Compartment syndrome

3. Dislocation An injury where bones forming a joint are pushed out of normal position Post traumatic / congenital Recurrent dislocations

4. General approach to dislocation Pain / deformity / restriction of movement History ( mechanism of injury , previous dislocations, comorbidities ) ABC Deformity/ skin / tenderness / restriction of movement / neurovascular injuries Plain Xray of affected joint ( confirm diagnosis / direction of dislocation / associated fractures / quality of bone )

5. Temporary immobilization of limb for pain relief Plan for closed reduction and splinting Post reduction x ray documentation - concentrically reduced joint - iatrogenic fractures - medicolegal purpose Duration of immobilization Rehabilitation plan

6. Shoulder dislocation Most common joint dislocation ( 50 %) Anatomically unstable joint Classified 1. anterior ( 90%) - subcoracoid - subglenoid - subclavicular - intrathoracic 2. posterior 3. inferior ( luxation erecta )

7. Duga test Hamilton rulter test

8. Callaway test Bryant test Affected side axillary fold appears elongated

9. Axillary nerve function – regiment patch anaesthesia

10. Xray – AP/ scapula y view / axillary lateral view

11. Axillary view

12. Scapula Y view

13. Associated # ( GT , neck of humerus )

14. Kocher method

15. Hippocratic method

16. Stimson technique

17. Rehabilitation 2 weeks of immobilization Check xray after 2 weeks Escalating joint ROM and muscle strengthening exercises Avoid Abd / ext rot

18. Posterior dislocation shoulder Electrocution / epilepsy Easily missed by clinician - lack of gross deformity - confusing xray finding

19. Axillary lateral view Scapula Y view

20. Inferior dislocation – luxatio erecta

21. KNEE DISLOCATION Rare injury (0.02%) High velocity RTA High risk of associated - neurovascular injury ( CPN – 25 %) - compartment syndrome - ligament injuries

22. Kennedy classification Anterior - most common - hyperextension mode - risk of CPN damage - PCL damage present Posterior - dash board injury - highest risk of popliteal artery injury Medial / lateral

23. Clinical findings

24. Treatment

25. HIP DISLOCATION Uncommon injuries associated with high velocity mechanism ( RTA) Associated injuries : sciatic nerve damage , femoral head or acetabular fractures Simple / complex Types - Anterior - Posterior - Central

26. Xray pelvis with bilateral hip _AP

27. Treatment Close reduction Open reduction

28. Allis maneuver

29. Baltimore maneuvre

30. Stimson’s maneuvre

31. Post reduction immobilization