Dislocations Flashcards
what MUST be examined and documented
vascular supply and neurology
what are the directions a shoulder can dislocate
anterior (most common)
posterior
inferior (rare)
who most commonly gets shoulder dislocations
young adults- sports
what is the most common mechanism of injury for anterior shoulder
fall with shoulder in external rotation
what is the anatomical position of anterior shoulder dislocation
humeral head anterior to the glenoid
where do you asses in an anterior shoulder dislocation
regimental badge area sensory assessment
what nerve are you testing in the regimental badge area
axillary nerve
what is the common mechanisms for a posterior shoulder dislocation
fall with shoulder in internal rotation
direct blow to anterior shoulder
what is the anatomical position of posterior shoulder dislocation
humeral head posterior to the glenoid
what does a light bulb sign suggest
posterior dislocation
what is the anatomical position of inferior shoulder dislocation
humeral head inferior to the glenoid
what does an inferior dislocation need
prompt neurovascular assessment and reduction
how do you manage a shoulder dislocation
closed reduction under sedation
open reduction
stabilisation and rehabilitation
what are the shoulder reduction methods
hippocratic
inline traction
who is more likely to get recurrent instability after a shoulder dislocation
younger patients
how do you dislocate your elbow
fall onto outstretched hand
what directions can you dislocate your elbow
posterior, anterior, medial/lateral/divergent
what is there a small risk of in elbow dislocations
radial head #
coronoid process #
how do you manage an elbow dislocation
closed reduction under sedation
open reduction (rarely required)
2 weeks in sling and rehabilitation
what are the reduction methods for an elbow dislocation
traction in extension +/- pressure over olecranon
what is the recurrent instability risk for elbow dislocation
low
how do you dislocate your IPJs
hyperextension injury
direct axial blow
what direction does the IPJs dislocate
almost always posterior
what can go wrong in an IPJ dislocation
head of phalanx button holes through your volar plate
recurrent instability due to associated fracture
how do you manage an IPJ dislocation
closed reduction under digital or metacarpal block
open reduction (rarely required)
2 weeks neighbour strapping
volar slab in edinburgh position if unstable
what are the reduction methods for IPJs dislocation
in line traction + corrective pressure
what is the purpose of the edinburgh position
prevents contracture of tendons
how do you dislocate your patella
sudden quads contraction with a flexing knee
what direction does a patella ‘always’ dislocate
lateral
who gets patella dislocations
teenagers, girls > boys
what is associated/ can cause patella dislocations
hypermobility
under-developed (hyperplastic) lateral femoral condyle
increased Q angle (genu valgum, increased femoral neck anteversion)
lateral quads insertions or weak vastus medialis
what lines make up the q angle
line from ASIS to midpoint of patella
line from tibial tubercle to midpoint of patella
what is seen on an exam in patella dislocation
pain medially (from torn medial retinaculum)
effusion (haemarthrosis)
patella apprehension test +ve
(often self relocating)
how do you manage a patella dislocation
reduce with knee extension radiographs aspiration brace physiotherapy
how do you manage repeat patella dislocations
surgery: lateral release/ medial reefing
patella tendon realignment
spontaneous knee relocations are common- what signs means the knee was definitely dislocated
lateral collateral lig injury + peroneal nerve injury = dislocationa
what nerve and artery is damaged in knee dislocations
peroneal
popliteal artery
what tests should be done for clinical suspicion of a vascular injury in knee dislocation
anteriogram/ MRI
check popliteal artery and vein
what is the urgent management for a knee dislocation
reduction under anaesthetic
theatre reduction if condyle button hole through capsule
stabilise in splint or external- fixation
what imaging for knee dislocation
plain radiographs- look for associated fractures
MRI
what are the surgery options for knee dislocations
early: vascular repair (6hr window), nerve repair
definitive: sequential ligamentous repair
what are the possible complications of knee dislocation sugery
Arthrofibrosis and stiffness
Ligament laxity
Nerve or arterial injury
what direction does a hip usually dislocate
posterior
what # are associated with a hip dislocation
posterior acetabular wall
femoral #
what is the presentation of a dislocated hip
flexed, internally rotated and adducted knee
what is the early management of a hip dislocation
neurovascular assessment (sciatic nerve) radiographs urgent reduction stabilise in traction if required further imaging (CT)
what is the definitive management of a hip dislocation
fixation of associated pelvic fractures
fixation of other injuries in poly trauam
what is the complications of a hip dislocation
sciatic nerve palsy
avascular necrosis of the femoral head
secondary osteoarthritis of hip
