DISLOCATIONSAND

TREATMENT

MUHAMMAD FARRUKH BASHIRFCPS (ORTHO)

JOINTS

• AC JOINT• SHOULDER• ELBOW• KNEE• HIP• ANKLE

SHOULDER

• ANATOMY

Pathoanatomy

BANKART LESIONAVULSION OF

ANTEROINFERIOR LABRUM

HILL SACHS LESIONPOSTEROLATERAL HEAD DEFECT

CLINICAL EVALUATION

• Prominent acromion, sulcus sign, palpable humeral head anteriorly

• Intense pain.

Types

• Anterior ..most common.• Posterior..(epileptic .electric shock)• Superior• Subcoracoid

Investigation

• AP • Axillary• Special Views:– West Point axillary: for visualization of glenoid rim– Hill-Sach view: internal rotation view– Stryker Notch: view 90% of posterolateral humeral head

Reduction

• Most Common Techniques – Kocher (71-100%)– External Rotation (78-90%) – Milch (70-89%) – Stimson (91-96%)– Traction/Countertraction– Scapular Manipulation (79-96%)

• Under proper analgesia

contd

• Kocher Arm is adducted and flexed at the elbow

• Externally rotate arm until resistance is felt• The ER arm is flexed forward as far as possible• The arm is internally rotated

Post reduction

• Only 2-3 weeks immoblization

HIP DISLOCTION

TYPES OF IP DISLOCATIONS

• POSTERIOR.MOST COMMON• ANTERIOR.• SUPERIOR• INFERIOR

Clinical

• Post :internally rotated shortened limb

Thompson and Epstein Classificationof Hip Dislocations

Type I Pure dislocation with at most a small wall fragment.

Type II Dislocation with large posterior wall fragment.

Type III Dislocation with comminuted posterior wall.

Type IV Dislocation with “acetabular floor” fracture (probably transverse + post. wall

acetabulum fracture-dislocation).

Type V Dislocation with femoral head fracture.

Investigation

• X rays;• AP• LATERAL• CT SCAN

REDUCTION

• ALLIS • EAST BALTIMORE• STIMSON• Open reduction

Post reduction

• Immoblize for 2-3 weeks.

Elbow dislocation

Terrible triad

Elbow dislocation+radial head Fx+coronoid

Fx+lateral colleteral ligament tear

Types

X ays

• AP• LATERAL• Ct scan

Reducton

• Close• Open • If unstale:

Post reduction

• Immoblize 2-3 weeks• Start ROM as early as possible….• Elbow notorious for adhesion.