Dislocation Flashcards
What is a dislocation
Complete separation of two articulating bone surfaces
What causes
Sudden impact
If recurrent can be due to low impact
What do you do if dislocated joint
Check neuromuscular status before and after reduction
2 view X-ray to confirm and look for fracture
X-ray after reduction
How is patient monitored if sedated
Doctor + nurse IV access as risk of reduced RR Observation after Go home with competent adult No driving for 24 hours
What is important to give before reduction
Analgesia for pain and to relax muscles
Entonox = pain and muscle relaxant
Proprofol if more needed
Theatre if complex / co-morbid
What do you do if fracture present
Reduction often done in theatre under GA
What is most common type of glenohumeral dislocation
Anterior = 90%
Posterior in epilepsy
Superior = rare and usually follows major trauma
What are other types of shoulder dislocations
Acromioclavicular - clavicle loses all attachment with acromion
Sternovlacivular
When is acromioclavicular common
Collision
Fall on shoulder
FOOSH
What are signs of anterior dislocation
Loss of shoulder contour Dip where head used to be Bump where it is lying now External rotation Abduction
What is often associated
Greater tuberosity of humerus fracture
Bankart lesion - damage to glenoid labrum
Hill Sachs - cortical depression of humeral head
What is common sign in posterior dislocation
Light bulb sign
Head looks more rounded
Internal rotation and adduction
What is important to check in shoulder dislocation
Sensory in badge area
Deltoid function / contraction
Axillary nerve can be damaged most commonly
Any part of brachial plexus
What views and what do they show
AP
Y view
If anterior then moves anterior to Y
If posterior then moves posterior to Y
How do you Rx glenohumeral
Prompt reduction
Immobilisation for 3 weeks with collar and cuff
Physio to strength rotator cuff
What do you do for recurrent
Surgical repair of Bankart tear
What do you do for different grades of acrmioclavicular
1+2 = conservative with sling 3+5 = surgical
What re complications of shoulder dislocation
Recurrent due to tear of labrum (Bankart)
Recurrent instability
Stiffness
Damage to axillary nerve (also in surgical neck of humerus fracture)
Damage to any part of brachial plexus
What is most common elbow dislocation
Posterior of radial head
What are articulations of elbow
Radial humeral
Ulnar humeral
Radial ulnar
How do you Rx
Posterior splint with elbow flexed at 90 for 2 weeks
What is associated
Radial head fracture
Ulnar and brachial artery injury
What is most common hip dislocation
Posterior
What is common if THR
Anterior
