Common dislocations and important ones Flashcards
What are the general principles of treatment of dislocations?
- 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:
- Stabilisation procedures
- Joint excision or replacement
What is the most common type of glenohumeral joint dislocations?
anterior dislocation - 98% of glenohumeral dislocations
What is the common mechanism of trauma injury causing an anterior glenohumeral joint dislocation?
- Severe external rotation (ER)
- Fall onto elbow
Apart from trauma what can be a caustative factor for anterior glenohumeral joint dislocation?
Ligamentus laxity
What are some of the clinical signs of anterior glenohumeral joint dislocation?
- Loss of symmetry & contour
- Patient supporting arm
What injury is shown here?
Anterior glenohumeral (shoulder) joint dislocation
What nerve is most commonly injured during a anterior glenohumeral (shoulder) glenohumeral joint dislocation?
Axillary nerve damage resulting in regimental badge patch area numbness. (loss of deltoid power?)
What is the acute treatment of an anterior shoulder dislocation (glenohumeral)?
reduction (may need anaesthetic if too sore) sometimes have to do open reduction
What are some of the techniques used to reduce an anterior dislocation of the shoulder?
- Traction
- Hippocratic
- Kocher manoeuvre
- Holding weight
After the shoulder has been reduced what investiagtion is carried out to confirm it has been done correctly?
Xray
What needs to be assessed after shoulder reduction?
Neurovascular status
Anterior shoulder dislocation usually results in detachment of the anterior ________\_ and capsule from the glenoid, what is this called?
Anterior shoulder dislocation usually results in detachment of the anterior labrum and capsule from the glenoid = bankart lesion
What is the long term management of anterior shoulder dislocation?
<20 = 80% chance redislocation – may offer surgical stabilisation (can be done arthroscopically), involves reattachment of bankart lesion
>30 = 20% chance redislocation - physio
What is a Hill-sach lesion and what injury is it associated with?
It is an impaction fracture posterior humeral head
List the injuries associated with an anterior shoulder dislocation?
- Rotator cuff tear
- Axillary nerve injury
- Greater tuberosity fracture
- Bankart lesion
- Hill-sach lesion
If there is pain not settling & evidence of impingement despite physio what investigations are carried out? (suspecting a rotator cuff tear)
US or MRI
What treatment would you consider for a rotator cuff tear not improving despite physio?
May consider subacromial decompression and cuff repair
What is the treatment of an associated greater tuberosity fracture in relation to anterior shoulder dislocation?
Usually reduces after reduction of GH joint, may need fixed if still displaced after reduction
If their is Generalised Ligamentous Laxity & Instability associated with an anterior shoulder dislocation, what is the treatment?
- Bankart repair insufficient
- Specialist physio can help avoid surgery
- If surgery a more invasive procedure is required
What do posterior shoulder dislocations occur in?
Siezures, electric shocks etc
What is the management of a posterior shoulder dislocation?
Closed reduction, sling & physio
What sign is often seen on Xray in posterior dislocations?
light bulb sign
How are AC joints usually dislocated ?
From a fall onto the shoulder (usually sports related)
What is the treatment of AC joint dislocations ?
If their is mild displacement with the coracoclavicular ligaments intact = conservative management
If ≥100% displacement can do coracoclavicular ligament reconstruction if not settling
what is the management of anterior sternoclavicular joint dislocations
do well if left alone
What are some of the complications of posterior sternoclavicular dislocations and hence their management?
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
If the elbow is dislocated with no other structures damaged what is done ?
Reduce, cast 1/52 then physio
What structures may fracture during an elbow dislocation?
- Radial head, ulna & coronoid may fracture
- Need to fix large fractures, may need to replace radial head, may need to repair ligaments
what is the most common type of finger dislocation?
Dorsal PIPJ
who is finger dislocations common in?
cricketers
What is the management of finger dislocations?
- Can reduce on pitch or under ring block with local anaesthetic
- Splint for 3 weeks – can tape to neighbouring finger and encourage early ROM
what deformities can arise due to finger dislocations?
- Swan neck deformity
- Boutonniere deformity
around 2-3 % fo THR dislocate what nerve is at risk of being damaged ?
sciatic nerve
