Professional Documents
Culture Documents
DISLOCATION
DEFINITION
It is complete and persistent displacement of a
joint in which at least part of the supporting joint
capsule and some of its ligaments are disrupted.
TYPES OF
DISLOCATION
Congenital
Acquired
1. Traumatic
2. Pathological e.g. TB hip, Septic Arthritis
3. Paralytic e.g. Poliomyelitis, cerebral palsy,
etc
4. Inflammatory disorders, rheumatoid
arthritis, etc
DISLOCATION
Most commonly occur in the following joints:
Shoulder
Hip
Elbow
Metacarpophalengeal joint
Facet joint dislocation in cervical spine.
Acromiclavicular joint dislocation.
PRINCIPLE OF
MANAGEMENT
Acute dislocation should be reduced as soon as
possible.
Open reduction is rarely necessary for acute
dislocation.
Close reduction with intravenous analgesia and
sedation or under GA should be attempted first
for most uncomplicated dislocation.
RICE : Rest, Immobilize, Cold, Elevate
PRINCIPLE OF
MANAGEMENT
It is an orthopedic emergency.
Reduction should be quick and prompt.
Reduction should always be under G/A or
sedation.
Swelling is less in compared to fractures.
Movements are more restricted than in
fractures.
PRINCIPLE OF
MANAGEMENT
Closed reduction is sufficient in most of the
times.
Open reduction is restored to if specifically
indicated.
Reduction techniques should always be very
gentle.
Pain will not subside by splinting unlike
fractures.
SHOULDER
DISLOCATION
Types:
Anterior dislocation:
Subcoracoid
Subglenoid
Sub-infraclavicular
Inferior
Posterior Dislocation
GLENOHUMERAL
DISLOCATION
ANTERIOR
DISLOCATION
REDUCTION
TECHNIQUES
REDUCTION
TECHNIQUES
KOCHERs Method
AFTER TREATMENT
The arm should be fasten to the chest with a body
bandage minimum period of three weeks.
ELBOW DISLOCATION
ELBOW DISLOCATION
Commonly due to fall on outstretched hand.
Closed reduction and long arm back slab for 3 weeks
is the treatment of choice.
HIP DISLOCATION
Thompson and Epstein classified posterior
dislocations of the hip into 5 types:
Type I
Type II
TYPE 1
TREATMENT
A type I dislocation is treated by closed reduction,
if possible, followed by immobilization in Buck
traction, an abduction pillow, knee immobilizer
(preventing hip flexion), or Thomas splint.
CLOSED REDUCTION
The following reduction maneuvers have been
described for posterior dislocations of the hip. The
gravity method of Stimson generally is believed to
be the least traumatic, but it is impractical in
patients with other injuries because it requires the
patient to lie prone.
GRAVITY METHOD OF
STIMSON
The patient is laid prone
on a table or cart with
both lower extremities
hanging off the end. An
assistant stabilizes the
pelvis, while the involved
hip and knee are flexed
90 degrees. The surgeon
grasps the leg just distal
to the flexed knee and
applies a longitudinal
force. Gentle internal and
external rotation of the
hip may aid the
reduction.
ALLIS MANEUVER
With the patient
supine, the pelvis is
stabilized by an
assistant applying
pressure to the anterior
superior iliac spines.
The surgeon applies
longitudinal traction in
the direct line of the
deformity followed by
flexion of the hip to 90
degrees while
continuing traction.
Internal and external
Allis reduction maneuver for posterior
rotations of the hip are
BIGELOW MANEUVER
With the patient supine, the
pelvis is stabilized by an
assistant applying pressure to
the anterior superior iliac
spines. The surgeon grasps the
affected limb by the ankle and
places his or her opposite
forearm beneath the patient's
flexed knee. Longitudinal
traction is applied in the
direction of the patient's
deformity, followed by flexion of
the patient's hip to 90 degrees
or more, while maintaining it in
an adducted, internally rotated Bigelow reduction maneuver
position and continuing
for posterior dislocation of
EAST BALTIMORE
With the patient supine, the surgeon stands on
the affected side with an assistant on the opposite
side. The patient's leg is flexed so that the hip and
knee are at 90 degrees. The surgeon places his or
her arm that is closest to the patient's head under
the proximal calf of the patient, cradling the leg in
his or her elbow with his or her hand resting on
the shoulder of the assistant. The surgeon's other
hand grips the patient's ankle. The assistant's arm
passes under the proximal calf of the patient
(similar to the surgeon's) and rests on the
surgeon's shoulder. The surgeon and assistant
squat slightly with knees bent. They straighten up
together to apply traction to the hip without
straining their backs. The surgeon rotates the leg
EAST BALTIMORE
OPEN REDUCTION
Anterior and posterior approaches have been
described for reduction of posterior dislocations of
the hip. Some authors have noted more frequent
osteonecrosis after the use of an anterior
approach, probably because the posterior
retinacular vessels are injured during the
dislocation, and the anterior approach injures the
remaining anterior vascular supply. Most of the
offending structures in an irreducible posterior
dislocation are reached more easily through a
posterior approach.
AFTER TREATMENT
The patient is put on surface traction for three
weeks.
Full weight bearing is permitted after 6 weeks.
KNEE JOINT
DISLOCATION
MP JOINT
DISLOCATION
IP DISLOCATION
Reduction Techniques..
THANK YOU