Dislocations- Lower Limb

Question 1

Hip dislocation

Answer 1

Significant force

Non-prosthetic = emergency
–> AVN of femoral head
–> Nerve injury

Reduce within 6 hours

POSTERIOR
- Most common, often dashboard
- Short, add, INT rot
- Risk to sciatic nerve (L5/S1, foot drop)

ANTERIOR
- Rare
- Risk to femoral a., v., n.

Question 2

Reduction techniques for hip dislocation:

Answer 2

1- Allis
- Stand on bed
- Vertical traction
- Slight ext rotation can help

2- Whistler
- Use your forearm as lever

3- Captain Morgan
- Use your knee as lever

Question 3

How soon should a hip dislocation be reduced?

Answer 3

Within 6 hours

The sooner the better: lower rates AVN + permanent nerve injury.

Question 4

Answer 4

Allis

Stand on bed
Vertical traction
As beigns to relocate, ext rotate and straighten

Question 5

Answer 5

Whistler

Drape leg over forearm (shown)
Vertical traction, lever down at ankle
Int.ext rotation PRN

Question 6

Answer 6

Captain Morgan

Drape leg over knee (shown)
Vertical traction, lever down at ankle
Int.ext rotation PRN

Question 7

Follow up care after hip reduction:

Answer 7

• Crutches initially and touch WB
• WBAT
• Avoid extremes of movement 4-6 weeks
  –> Incl. don’t flex hips beyond 45 (ie. NO SITTING!)

Question 8

Follow up care after hip reduction:

Answer 8

• Crutches initially
• WBAT
• Avoid extremes of movement 4-6 weeks
  –> Incl. don’t flex hips beyond 45 (will need to sit straightened out!)

Question 9

Knee Dislocation: incl. reduction

Answer 9

Anterior most common (hyperextension)

HALF spontaneously reduce prior to ED

These are limb-threatening injuries

80% rate of NV injury
–> Popliteal artery
–> Peroneal nerve (foot drop, sensation to ant leg/foot)

Reduce within 6 hours
–> Simple traction enough usually (unstable +)

Post reduction: VASCULAR STATUS
- ‘Hard/ soft’ signs
- Pulses
- ABI
- CT angio

Immobilise at 20degr
ALL need OT stabilisation ultimately

Question 10

Which knee dislocation is irreduceable in ED?

Answer 10

PosteroLATERAL

‘Dimple’ sign medial joint

Question 11

Patellar dislocation

Answer 11

Almost all lateral
Many spontaneously reduce
–> Apprehension test
–> Push patella laterally whilst flexing knee. Pt will try and stop you.

Reduce by:
- Push patella medially with thumbs, whilst extending knee

Can WBAT