Common Dislocations Flashcards
What is important in the history taking of dislocations?
TRAUMA: falls, RTA, sports injuries, seizures
What type of examination should be done in dislocations?
Inspection: deformity
Palpation: vascular supply, neurology - must be examined and documented before intervention
What is the common mechanism of injury that leads to a shoulder dislocation?
Fall with the shoulder in external rotation - anterior
Fall with the shoulder in internal rotation or direct blow to the shoulder - posterior
Arm held in abduction - inferior
How can a shoulder dislocate?
Anteiror - common
Posterior
Inferior - RARE
Who is likely to get a shoulder dislocation?
Common in young adults
What neurological assessment needs to be done in anterior dislocations?
Regimental badge area sensory assessment - axillary nerve
What neurological disorder are posterior dislocations associated with?
Seizure
What is the cardinal sign of a posterior dislocation on x-ray?
Light bulb sign
How is a shoulder dislocations managed?
Closed reduction under stabilisation
Open reduction
Stabilistaion and rehabilitation
What is the type of reduction method used in closed shoulder reductions?
Hippocratic, in-line traction
What directions can an elbow dislocate?
Posterior
Anterior
Divergent
Medial/ lateral
What are the associated fracture risks with elbow dislocations?
Radial head or coronoid process
What structures are at risk with an elbow dislocation?
Anteriorly: brachial artery and median nerve
Posteriorly: radial nerve
How can neurovascular status be assessed in children?
Make an OK sign: median nerve
Point - motor of radial
Starfish - ulnar
How can an elbow dislocation be managed?
Closed reduction under sedation
Open reduction is rarely needed
2 weeks in a sling and rehab
What are the different reduction methods utilised in elbow dislocations?
Traction in extension +/- pressure over the olecranon
What is the mechanism of injury of an IPJ?
Hyperextension with a direct axial blow
What way with an IPJ dislocate?
Almost always posterior
What complications can occur with IPJ dislocations?
Head of phalanx button-holes through volar plate
Recurrent instability due to associated fracture
What is the management for an IPJ dislocation?
Closed recution under digital or metacarpal block
2 weeks in neighbour strapping
Volar slab in edinburgh position if unstable
What reduction methods are used for IPJ dislocations?
In line traction with corrective pressure
What is the mechanism for patellar dislocation?
Sudden quads contraction with a flexing knee
How will the patella dislocate?
Always laterallly
Who is likely to get a patellar dislocation?
Most common in teenage girls
What can cause patellar dislocations?
Hypermobility
Under-developed lateral femoral condyle
Increased Q angle (genu valgum, increased femoral neck anteversion)
Lateral quads insertions or weak vastus medialis
What is the Q angle?
Line from ASIS to midpoint of patella
Second line from tibial tubercle to midpoint of patella
How will a patellar dislocation present?
Clear history of patella dislocating laterally
Self-relocating
What will a patellar dislocation show upon examination?
Pain medially from a torn medial retinaculum
Haemarthrosis
Patellla apprehension test
How are patellar dislocations managed?
Reduce with knee extension Radiographs Aspiration Brace PT
What surgery can be performed for recurrent dislocations?
Lateral release
Patella tendon realignment
Reconstruction of MPFL with a graft
Why should a spontaneous knee relocation not be missed?
LCL injury
Fibular nerve injury
What type of knee dislocation can injure the popliteal artery?
Posterior dislocation
What shouldy you do if you suspect a vascular injury in a knee dislocation?
Arteriogram/ MRI
How is a knee dislocation managed?
Reduction under sedation
May require theatre reduction if condyle button holed through the capsule
What are the complications of a knee dislocations?
Arthrofibrosis and stiffness
Ligament laxity
Nerve or arterial injury
What are the common mechanisms of hip dislocations?
High velocity: RTA dashboard injury, fall from height
What direction will hips commonly dislocate?
Posteriorly
What are the associated fractures that can occur with a hip dislocation?
Posterior acetabular wall
Femoral
How will a dislocated knee present?
Flexed, internally rotated and adducted
How is a dislocated hip managed?
Neurovascular assessment (esp. sciatic nerve) Radiographs Urgent reduction Stabilise in tractions if required CT
What are the complications of hip dislocations?
Sciatic nerve palsy
AVN of the femoral head
Secondary OA
