Common Dislocations Flashcards

1
Q

Where are common sites of dislocations?

A

Elbow, hip, shoulder, IP joints, patella, knee

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2
Q

What are common features of the history and examination in all dislocations?

A

Trauma = fall, RTA, sports injury, seizure
Inspection for deformity
Palpating = vascular supply, neurology

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3
Q

What are the common mechanics of shoulder dislocations, and what directions can the dislocations go in?

A

Fall, traction injury, common in young adults

Directions = anterior (most common), posterior, inferior (rare)

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4
Q

What are some features of an anterior shoulder dislocation?

A

Fall with shoulder in external rotation, humeral head anterior to glenoid, needs regimental badge area sensory assessment (axillary nerve)

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5
Q

What are some features of posterior shoulder dislocations?

A

Fall with shoulder in internal rotation, direct blow to anterior shoulder, humeral head posterior to glenoid

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6
Q

What are some features of inferior shoulder dislocations?

A

Arm held in abduction, humeral head inferior to glenoid, needs prompt neurovascular assessment and reduction

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7
Q

What are some management options for shoulder dislocations?

A

Closed reduction under sedation, open reduction, stabilisation and rehabilitation
Reduction methods = Hippocratic, in-line traction

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8
Q

What is a complication of shoulder dislocations?

A

Recurrent instability risk = related to age, risk of recurrence decreases with age

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9
Q

How do elbow dislocations arise, and in what direction can it be dislocated?

A

Mechanism = fall onto outstretched hand
Directions = anterior, posterior, medial/lateral
Occurs in adults and children

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10
Q

What are some risks associated with elbow dislocations?

A

Small risk of radial head or coronoid process fracture

Low risk of recurrence

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11
Q

How should elbow dislocations be managed?

A

Closed reduction under sedation, open reduction rarely required, 2 weeks in sling and rehabilitation
Reduction methods = traction in extension +/- pressure over olecranon

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12
Q

What are some features of interphalangeal (IP) dislocations?

A

Mechanism = hyperextension, direct axial blow

Always displaced posteriorly

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13
Q

What are some complications of IP dislocations?

A

Head of phalanx button holes through volar plate, recurrent instability due to associated fracture

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14
Q

How should interphalangeal dislocations be managed?

A

Closed reduction under digital/metacarpal block, open reduction rarely required, 2 weeks in neighbouring strapping, volar slab in Edinburgh position if unstable

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15
Q

What reduction methods can be used to treat IP dislocations?

A

In-line traction plus corrective pressure

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16
Q

What are some features of patellar dislocations?

A

Mechanism = sudden quads contraction with a flexing knee
Always displaced laterally
Most common in teenagers, more common in girls

17
Q

What are some causes of patellar dislocations?

A

Hypermobility, under-developed (hypoplastic) lateral femoral condyle, increased Q angle, genu valgum, increased femoral neck anteversion, lateral quads insertion or weak vastus medialis

18
Q

How do patients present with a patellar dislocation?

A

Clear history of patella dislocating laterally, often self-relocating

19
Q

What would you expect to find on examination of a patient with patellar dislocation?

A

Pain medially = from torn medial retinaculum
Effusion = haemarthrosis
Positive patellar apprehension test

20
Q

How are patellar dislocations treated?

A

Reduce with knee expansion, radiographs, aspiration, brace, physio
Surgery for repeat dislocations = lateral release/medial reefing, patella tendon realignment

21
Q

How do knee dislocations occur and who gets them?

A

Mechanism = high or low velocity injuries

Most common in teenagers, more common in girls

22
Q

Why are knee dislocations missed, and why is it important that they are discovered?

A

May spontaneously relocate = lateral collateral ligament or peroneal nerve may be injured in initial dislocation

23
Q

What should you do in a patient with a normal examination but high clinical suspicion of a knee dislocation?

A

Observe in hospital and get arteriogram/MRI

24
Q

What structures may be damaged in a knee dislocation?

A

Peroneal nerve

Popliteal artery and vein = may not be obvious (intimal tear/thrombus)

25
How should ligamentous stability be examined in a patient with a knee dislocation?
Under anaesthetic
26
What is the urgent management for a knee dislocation?
Reduction under sedation, may require theatre reduction if condyle has button-holed through capsule, stabilise in splint or external-fixation
27
What methods are used to image a dislocated knee?
Plain radiographs, MRI
28
What surgery can be done for knee dislocations?
Early surgery = vascular repair (6hr window), nerve repair | Definitive surgery = sequential ligamentous repair
29
What are some potential complications of a knee dislocation?
Arthrofibrosis and stiffness, ligament laxity, nerve or arterial injury
30
What are some features of a hip dislocation?
Mechanism = RTA dashboard injury, fall from height Most commonly posteriorly displaced Associated fractures = posterior acetabulum wall, femoral
31
How di hip dislocations present?
Flexed, internally rotated and adducted knee
32
What is the early management of a hip dislocation?
Neurovascular assessment (especially sciatic nerve) Radiographs (changes can be subtle) Urgent reduction and stabilise in tractions if needed Further imaging with CT
33
What is the definitive management for a hip dislocation?
Fixation of associated pelvic fractures | Fixation of other injuries in poly-trauma patients
34
What are some complications of hip dislocations?
Sciatic nerve palsy, avascular necrosis of femoral head, secondary osteoarthritis of hip