Dislocations

Question 1

what MUST be examined and documented

Answer 1

vascular supply and neurology

Question 2

what are the directions a shoulder can dislocate

Answer 2

anterior (most common)
posterior
inferior (rare)

Question 3

who most commonly gets shoulder dislocations

Answer 3

young adults- sports

Question 4

what is the most common mechanism of injury for anterior shoulder

Answer 4

fall with shoulder in external rotation

Question 5

what is the anatomical position of anterior shoulder dislocation

Answer 5

humeral head anterior to the glenoid

Question 6

where do you asses in an anterior shoulder dislocation

Answer 6

regimental badge area sensory assessment

Question 7

what nerve are you testing in the regimental badge area

Answer 7

axillary nerve

Question 8

what is the common mechanisms for a posterior shoulder dislocation

Answer 8

fall with shoulder in internal rotation

direct blow to anterior shoulder

Question 9

what is the anatomical position of posterior shoulder dislocation

Answer 9

humeral head posterior to the glenoid

Question 10

what does a light bulb sign suggest

Answer 10

posterior dislocation

Question 11

what is the anatomical position of inferior shoulder dislocation

Answer 11

humeral head inferior to the glenoid

Question 12

what does an inferior dislocation need

Answer 12

prompt neurovascular assessment and reduction

Question 13

how do you manage a shoulder dislocation

Answer 13

closed reduction under sedation
open reduction
stabilisation and rehabilitation

Question 14

what are the shoulder reduction methods

Answer 14

hippocratic

inline traction

Question 15

who is more likely to get recurrent instability after a shoulder dislocation

Answer 15

younger patients

Question 16

how do you dislocate your elbow

Answer 16

fall onto outstretched hand

Question 17

what directions can you dislocate your elbow

Answer 17

posterior, anterior, medial/lateral/divergent

Question 18

what is there a small risk of in elbow dislocations

Answer 18

radial head #

coronoid process #

Question 19

how do you manage an elbow dislocation

Answer 19

closed reduction under sedation
open reduction (rarely required)
2 weeks in sling and rehabilitation

Question 20

what are the reduction methods for an elbow dislocation

Answer 20

traction in extension +/- pressure over olecranon

Question 21

what is the recurrent instability risk for elbow dislocation

Answer 21

low

Question 22

how do you dislocate your IPJs

Answer 22

hyperextension injury

direct axial blow

Question 23

what direction does the IPJs dislocate

Answer 23

almost always posterior

Question 24

what can go wrong in an IPJ dislocation

Answer 24

head of phalanx button holes through your volar plate

recurrent instability due to associated fracture

Question 25

how do you manage an IPJ dislocation

Answer 25

closed reduction under digital or metacarpal block open reduction (rarely required) 2 weeks neighbour strapping volar slab in edinburgh position if unstable

Question 26

what are the reduction methods for IPJs dislocation

Answer 26

in line traction + corrective pressure

Question 27

what is the purpose of the edinburgh position

Answer 27

prevents contracture of tendons

Question 28

how do you dislocate your patella

Answer 28

sudden quads contraction with a flexing knee

Question 29

what direction does a patella 'always' dislocate

Answer 29

lateral

Question 30

who gets patella dislocations

Answer 30

teenagers, girls > boys

Question 31

what is associated/ can cause patella dislocations

Answer 31

hypermobility under-developed (hyperplastic) lateral femoral condyle increased Q angle (genu valgum, increased femoral neck anteversion) lateral quads insertions or weak vastus medialis

Question 32

what lines make up the q angle

Answer 32

line from ASIS to midpoint of patella line from tibial tubercle to midpoint of patella

Question 33

what is seen on an exam in patella dislocation

Answer 33

pain medially (from torn medial retinaculum) effusion (haemarthrosis) patella apprehension test +ve (often self relocating)

Question 34

how do you manage a patella dislocation

Answer 34

``` reduce with knee extension radiographs aspiration brace physiotherapy ```

Question 35

how do you manage repeat patella dislocations

Answer 35

surgery: lateral release/ medial reefing | patella tendon realignment

Question 36

spontaneous knee relocations are common- what signs means the knee was definitely dislocated

Answer 36

lateral collateral lig injury + peroneal nerve injury = dislocationa

Question 37

what nerve and artery is damaged in knee dislocations

Answer 37

peroneal | popliteal artery

Question 38

what tests should be done for clinical suspicion of a vascular injury in knee dislocation

Answer 38

anteriogram/ MRI | check popliteal artery and vein

Question 39

what is the urgent management for a knee dislocation

Answer 39

reduction under anaesthetic theatre reduction if condyle button hole through capsule stabilise in splint or external- fixation

Question 40

what imaging for knee dislocation

Answer 40

plain radiographs- look for associated fractures | MRI

Question 41

what are the surgery options for knee dislocations

Answer 41

early: vascular repair (6hr window), nerve repair definitive: sequential ligamentous repair

Question 42

what are the possible complications of knee dislocation sugery

Answer 42

Arthrofibrosis and stiffness Ligament laxity Nerve or arterial injury

Question 43

what direction does a hip usually dislocate

Answer 43

posterior

Question 44

what # are associated with a hip dislocation

Answer 44

posterior acetabular wall | femoral #

Question 45

what is the presentation of a dislocated hip

Answer 45

flexed, internally rotated and adducted knee

Question 46

what is the early management of a hip dislocation

Answer 46

``` neurovascular assessment (sciatic nerve) radiographs urgent reduction stabilise in traction if required further imaging (CT) ```

Question 47

what is the definitive management of a hip dislocation

Answer 47

fixation of associated pelvic fractures | fixation of other injuries in poly trauam

Question 48

what is the complications of a hip dislocation

Answer 48

sciatic nerve palsy avascular necrosis of the femoral head secondary osteoarthritis of hip