Subluxation and dislocation

Question 1

What injury typically results from a pulled arm in a child?

Answer 1

Subluxation of the radial head resulting in reduced ability to supinate or flex at the elbow joint.

Question 2

How is radial head subluxation managed beyond analgesia?

Answer 2

Passive supination of the elbow joint whilst flexed to 90 degrees to reduce the displacement.

Question 3

who is at risk of subluxation of the radial joint?

Answer 3

children under 6 are most at risk due to the weakened annular ligament in children of this age.

Question 4

How are acromioclavicular joint injuries usually sustained?

Answer 4

collision sports or falls on outstretched hand (FOOSH)

Question 5

How are AC joint injuries graded?

Answer 5

by degree of separation I-VI. Grades I-II managed with rest and a sling. IV-VI managed with surgical intervention.

Question 6

findings of flattened shoulder contour, small bulge beneath the clavicle and a patch of anaesthesia over the distal deltoid muscle is indicative of what type of injury?

Answer 6

Anterior shoulder dislocation

Question 7

What types of glenohumeral dislocations can take place?

Answer 7

Anterior shoulder dislocation - external rotation and abduction,3-40% recurrent, ass. with greater tuberosity fracture, Bankart lesion and hill-sachs defect.
Posterior shoulder dislocation - often misdiagnosed, Rim’s sign, light bulb sign, ass. with Trough sign. Also inferior and superior dislocation.

Question 8

How should shoulder displacement be managed?

Answer 8

Prompt reduction. Neurovascular status pre and post. In recurrent dislocation a bankart lesion (glenoid labrum) may require surgical repair

Question 9

List the dislocations in the shoulder region

Answer 9

Glenohumeral, acromioclavicular (clavicle loses attachment with the scapula) Sternoclavicular dislocation.

Question 10

How would a posterior hip dislocation present?

Answer 10

Typically an RTA Posterior dislocation: Accounts for 90% of hip dislocations. The affected leg is shortened, adducted, and internally rotated.

Question 11

How would an anterior hip dislocation present?

Answer 11

The affected leg is usually abducted and externally rotated. No leg shortening. May also have a palpable bulge of the femoral head.

Question 12

When might a central dislocation be incurred?

Answer 12

Side on collision in an RTA

Question 13

What are the potential complications of a hip dislocation

Answer 13

Sciatic or femoral nerve injury
Avascular necrosis
Osteoarthritis: more common in older patients.
Recurrent dislocation: due to damage of supporting ligaments