Common dislocations and important ones

Question 1

What are the general principles of treatment of dislocations?

Answer 1

• Need prompt reduction usually by closed means
• Some require open reduction if soft tissues in way
• Late presentation may not be able to reduce closed and risk of poor outcome greater
• Need to assess neurovascular status before and after reduction
• Short period of splintage usually sufficient
• Some may benefit from surgery:

1. Stabilisation procedures
2. Joint excision or replacement

Question 2

What is the most common type of glenohumeral joint dislocations?

Answer 2

anterior dislocation - 98% of glenohumeral dislocations

Question 3

What is the common mechanism of trauma injury causing an anterior glenohumeral joint dislocation?

Answer 3

• Severe external rotation (ER)
• Fall onto elbow

Question 4

Apart from trauma what can be a caustative factor for anterior glenohumeral joint dislocation?

Answer 4

Ligamentus laxity

Question 5

What are some of the clinical signs of anterior glenohumeral joint dislocation?

Answer 5

• Loss of symmetry & contour
• Patient supporting arm

Question 6

What injury is shown here?

Answer 6

Anterior glenohumeral (shoulder) joint dislocation

Question 7

What nerve is most commonly injured during a anterior glenohumeral (shoulder) glenohumeral joint dislocation?

Answer 7

Axillary nerve damage resulting in regimental badge patch area numbness. (loss of deltoid power?)

Question 8

What is the acute treatment of an anterior shoulder dislocation (glenohumeral)?

Answer 8

reduction (may need anaesthetic if too sore) sometimes have to do open reduction

Question 9

What are some of the techniques used to reduce an anterior dislocation of the shoulder?

Answer 9

• Traction
• Hippocratic
• Kocher manoeuvre
• Holding weight

Question 10

After the shoulder has been reduced what investiagtion is carried out to confirm it has been done correctly?

Answer 10

Xray

Question 11

What needs to be assessed after shoulder reduction?

Answer 11

Neurovascular status

Question 12

Anterior shoulder dislocation usually results in detachment of the anterior ________\_ and capsule from the glenoid, what is this called?

Answer 12

Anterior shoulder dislocation usually results in detachment of the anterior labrum and capsule from the glenoid = bankart lesion

Question 13

What is the long term management of anterior shoulder dislocation?

Answer 13

<20 = 80% chance redislocation – may offer surgical stabilisation (can be done arthroscopically), involves reattachment of bankart lesion

>30 = 20% chance redislocation - physio

Question 14

What is a Hill-sach lesion and what injury is it associated with?

Answer 14

It is an impaction fracture posterior humeral head

Question 15

List the injuries associated with an anterior shoulder dislocation?

Answer 15

• Rotator cuff tear
• Axillary nerve injury
• Greater tuberosity fracture
• Bankart lesion
• Hill-sach lesion

Question 16

If there is pain not settling & evidence of impingement despite physio what investigations are carried out? (suspecting a rotator cuff tear)

Answer 16

US or MRI

Question 17

What treatment would you consider for a rotator cuff tear not improving despite physio?

Answer 17

May consider subacromial decompression and cuff repair

Question 18

What is the treatment of an associated greater tuberosity fracture in relation to anterior shoulder dislocation?

Answer 18

Usually reduces after reduction of GH joint, may need fixed if still displaced after reduction

Question 19

If their is Generalised Ligamentous Laxity & Instability associated with an anterior shoulder dislocation, what is the treatment?

Answer 19

• Bankart repair insufficient
• Specialist physio can help avoid surgery
• If surgery a more invasive procedure is required

Question 20

What do posterior shoulder dislocations occur in?

Answer 20

Siezures, electric shocks etc

Question 21

What is the management of a posterior shoulder dislocation?

Answer 21

Closed reduction, sling & physio

Question 22

What sign is often seen on Xray in posterior dislocations?

Answer 22

light bulb sign

Question 23

How are AC joints usually dislocated ?

Answer 23

From a fall onto the shoulder (usually sports related)

Question 24

What is the treatment of AC joint dislocations ?

Answer 24

If their is mild displacement with the coracoclavicular ligaments intact = conservative management

If ≥100% displacement can do coracoclavicular ligament reconstruction if not settling

Question 25

what is the management of anterior sternoclavicular joint dislocations

Answer 25

do well if left alone

Question 26

What are some of the complications of posterior sternoclavicular dislocations and hence their management?

Answer 26

Can compress trachea, oesophagus or brachiocephalic vein resulting in:

• Dyspnoea
• Dysphagia
• Venous congestion

Hence are reduced and may need a surgical instrument to hold bone

Question 27

If the elbow is dislocated with no other structures damaged what is done ?

Answer 27

Reduce, cast 1/52 then physio

Question 28

What structures may fracture during an elbow dislocation?

Answer 28

• Radial head, ulna & coronoid may fracture
• Need to fix large fractures, may need to replace radial head, may need to repair ligaments

Question 29

what is the most common type of finger dislocation?

Answer 29

Dorsal PIPJ

Question 30

who is finger dislocations common in?

Answer 30

cricketers

Question 31

What is the management of finger dislocations?

Answer 31

• Can reduce on pitch or under ring block with local anaesthetic
• Splint for 3 weeks – can tape to neighbouring finger and encourage early ROM

Question 32

what deformities can arise due to finger dislocations?

Answer 32

• Swan neck deformity
• Boutonniere deformity

Question 33

around 2-3 % fo THR dislocate what nerve is at risk of being damaged ?

Answer 33

sciatic nerve