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Year 2 Clinical > Common Dislocations > Flashcards

Common Dislocations Flashcards

1
Q

General principles of assessment and treatment of common dislocations?

A

Prompt reduction (usually closed); if presentation is late, closed reduction may not be possible and the risk of a poor outcome is higher

Assess neurovascular status BEFORE AND AFTER reduction

A short period of splintage is normally enough but some may benefit from surgery, e.g:
• Stabilisation procedures
• Joint excision or replacement

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2
Q

Occurrence of shoulder dislocations?

A

Vast majority of GH joint dislocations are ANTERIOR

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3
Q

Types of shoulder dislocations?

A

Traumatic, e.g:
• Severe external rotation
• Fall onto an elbow

Atraumatic, e.g:
• Ligamentous laxity (youngsters)
• CTDs, like Ehler-Danlos syndrome

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4
Q

Clinical signs of a shoulder dislocation?

A

Loss of symmetry and contour

Patient supports arm due to apprehension and pain

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5
Q

Nerve and arterial injuries assoc. with anterior shoulder dislocation?

A

AXILLARY NERVE PALSY is the commonest assoc. nerve injury, causing:
• Numbness in the “badge patch” area (where soldiers where stripes)
• Unable to assess deltoid function acutely

Effect on any part of the brachial plexus or on axillary artery

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6
Q

Lesions assoc. with anterior shoulder dislocation?

A

Bankart lesion - anterior dislocation usually causes detachment of the anterior labrum and capsule from the glenoid

Hill-Sachs lesion - may also have an impaction fracture on the posterior humeral head

Can also have an assoc. :
• Rotator cuff tear
• Fracture of the great tuberosity

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7
Q

Ix for shoulder dislocations?

A

X-ray - appears obvious

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8
Q

Reduction techniques?

A
  • Traction (most common)
  • Hippocratic
  • Holding weight
  • Kocher manoeuvre
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9
Q

Re-dislocation rates for anterior shoulder dislocations?

A

If <20 years, 80% chance of re-dislocation:
• Offer surgical stabilisation

If >30 years, 20% chance of redislocation:
• Offer physiotherapy

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10
Q

General treatment principles for anterior shoudler dislocation?

A

Reduction

Most are then in a broad-arm sling for 3 weeks, followed by physio

Surgical stabilisation offered for recurrent dislocation or for those <20 years:
• Reattachment of Bankart lesion
• Can be done arthroscopically

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11
Q

Signs of axillary nerve injury?

A

Usually, neurapraxia and this tends to resolve

Axonotmesis may/may not resolve

Persistent loss of deltoid power is very difficult to treat

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12
Q

Ix and treatment options for a rotator cuff tear assoc. with anterior shoulder dislocation?

A

If, despite physio, pain is not resolving and there is evidence of impingement:
• US or MRI

Consider subacromial decompression and cuff repair

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13
Q

Treatment of a greater tuberosity fracture assoc. with anterior shoulder dislocation?

A

Tends to reduce after reduction of GH joint

It may need to be fixed if it remains substantially displaced

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14
Q

Treatment of generalised ligamentous laxity and instability assoc. with a shoulder dislocation?

A

If there is evidence of hypermobility, a Bankart repair is insufficient

Specialised physio can help avoid surgery but sometimes it cannot be avoided

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15
Q

Occurrence of posterior shoulder dislocations?

A

Uncommon

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16
Q

Cause of posterior shoulder dislocations?

A

Posterior force on adducted and internally rotated shoulder

May occur during a seixure

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17
Q

Ix for posterior shoulder dislocations?

A

X-ray - light bulb sign indicates a severely internally rotated humeral head

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18
Q

Treatment of posterior shoulder dislocations?

A

Closed reduction and sling

Physiotherapy

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19
Q

Describe an AC joint dislocation?

A

From a fall onto the shoulder that is usually sports-related

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20
Q

Treatment of AC joint dislocation?

A

If there is mild displacement and the coracoclavicular ligaments are intact:
• Conservative Mx

If ≥100 displacement and persistent pain, even with conservative Mx:
• Coracoclavicular ligament reconstruction

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21
Q

Types of SC joint dislocations? Treatment?

A

Anterior - bony lump that can be left alone

Posterior - can compress trachea, oesophagus or brachiocephalic vein and cause:
• Dyspnoea
• Dysphagia
• Venous congestion 
These must be reduced
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22
Q

Occurrence of elbow dislocations?

A

2nd most common dislocation in the body

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23
Q

Treatment of a pure elbow dislocation?

A

THERE IS NO FRACTURE

Reduction and then casting for 1 week, followed by physio

Good prognosis

24
Q

Potential fracture sits in an elbow fracture-dislocation?

A
  • Radial head
  • Ulna
  • Coronoid process
25
Q

Treatment of elbow fracture-dislocations?

A

Fix large fractures

May need to replace the radial head

May need to repair ligaments

26
Q

Complications of elbow-fracture dislocations?

A

High risk of stiff elbow

27
Q

Types of forearm fracture-dislocations?

A
  • Monteggia

* Galeazzi

28
Q

Treatment of forearm fracture-dislocations?

A

Fix fracture

Reduce dislocation

29
Q

What are perilunate dislocations?

A

Rare but often missed on initial imaging, leading to rapidly progressive wrist OA

Inv. dislocation of the carpus relative to the lunate, which remains in normal alignment with the distal radius

30
Q

Ix for perilunate dislocations?

A

X-ray:
• AP views tends to be normal (may see a slightly flexed scaphoid forming the O-sign OR the lunate will have a triangular appearance, forming the piece-of-pie sign)

• Lateral view is required

31
Q

Treatment of perilunate dislocations?

A

URGENT REDUCTION and stabilisation (wires)

If late presentation, open reduction

32
Q

Problems assoc. with a perilunate dislocations?

A

May have a concurrent scaphoid fracture

33
Q

Types of finger dislocations?

A
  • Dorsal PIPJ dislocations (most common)

* Volar PIPJ and dorsal DIPJ dislocations

34
Q

Occurrence of finger dislocations?

A

Common in cricketers

35
Q

Treatment of finger dislocations?

A

Can reduce on the pitch or under ring-block with local anaesthetic

Splint for 3 weeks and can tape to the neighbouring finger and encourage early ROM

DO NOT USE ADRENALINE IN FINGERS

36
Q

Complications of finger dislocations?

A

Can lead to swan-neck deformity, with disruption of the volar plate

OR

Boutonniere deformity with disruption of the central slip of extensor tendon

37
Q

Describe hip fracture

A

Native hip only dislocates with high-energy injury, e.g: road-traffic accidents

There is a high incidence of other injuries so ABCD

38
Q

Injuries assoc. with hip fracture?

A

Fracture of the posterior wall acetabulum

Femoral head avulsion fracture, from ligamentum teres

39
Q

Treatment of hip dislocation?

A

Emergency reduction

May require internal fixation if there is a:
• Large acetabular wall fracture
• Femoral head fracture

40
Q

Complications of hip dislocations?

A

Risk of AVN and heterotopic ossification

41
Q

Describe dislocations of hip replacement

A

Anteriorly/posteriorly and may injure the sciatic nerve

Abductors usually tear

42
Q

Treatment of dislocations of hip replacement?

A

1st time:
• Closed reduction and knee splint

Recurrent dislocation may need revision surgery:
• Can implant a “restrained” cup, preventing dislocation but reducing ROM and may not last as long

43
Q

Occurrence of patellar dislocation?

A

Fairly common, esp. in adolescents

44
Q

Describe a patellar dislocation

A

Dislocates LATERALLY from sudden quads contraction +/- direct blow (e.g: clash of knees)

There is an obvious deformity, with the patella sitting on the side of the knee

45
Q

Assoc. injuries with patellar dislocation?

A

May have an osteochondral fracture that causes lipohaemarthrosis (fluid level on X-ray) +/- a loose body in the knee

46
Q

Factors that predispose to patellar dislocation?

A
  • Female
  • <20 years of age
  • Ligamentous laxity, e.g: in Ehlers-Danlos syndrome
  • Genu valgum
  • Shallow trochlea
  • Femoral neck anteversion
47
Q

Treatment of patellar dislocation?

A

Reduction and splint for 3 weeks, followed by physio

48
Q

Recurrence risk of patellar dislocation?

A

10-30% recurrence with 1st time dislocation

50% recurrence with 2nd time:
• May offer surgical stabilisation and medial patello-femoral ligament (MPFL) reconstruction

49
Q

Describe knee dislocations

A

Serious injuries with a high incidence of:
• Popliteal artery injury
• Common fibular nerve injury
• Compartment syndrome (due to vascular and re-perfusion injury)

50
Q

Treatment of knee dislocations?

A

Emergency reductions, external fixation +/- revascularisation

Usually requires multiligament reconstruction

51
Q

Treatment of ankle fracture-dislocations (ankle tends to have a fracture with dislocation)?

A

Fixation stabilises the joint

52
Q

Describe subtalar joint dislocation

A

High-energy injuries, usually with medial dislocation

53
Q

Treatment of subtalar dislocation?

A

Reduction and a cast for 3 weeks

If soft tissues are interposed, may require open reduction

54
Q

Assoc. problems with subtalar dislocation?

A

Can be assoc. with a talar neck fracture, AKA “Aviator’s Astragalus”

High risk of AVN

Pressure on skin can produce white skin; this is a bad sign of oncoming skin necrosis and wound breakdown

55
Q

Describe tarso-metatarsal dislocations

A

AKA Lisfranc fracture-dislocation - rotation of a hyperplantarflexed foot

56
Q

Ix for Lisfranc fracture-dislocation?

A

X-ray - subtle signs:
• Look for flake fractures at the base of the 2nd metatarsal
• Too much space between the 1st and 2nd metatarsals
• Cuneiforms and metatarsals may not align

May need CT scans +/- stress X-rays to diagnose

57
Q

Complications of untreated Lisfranc fractures?

A

Chronic forefoot pain and requirement for internal fixation

Year 2 Clinical (119 decks)

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