Slide 1

Acute Joint Dislocation Dr. Abdulrahman Algarni, MD, SSC (Ortho), ABOS Assist. Professor, King Saud University Consultant Orthopedic and Arthroplasty Surgeon

Slide 2

objectives To know mechanisms of the most common joint dislocations Be able to make the diagnosis To know and interpret the appropriate x-rays To know the common complications and how to avoid them

Slide 3

Acute Joint Dislocation Complete separation of the articular surface: Joint surfaces are no longer in contact Position of distal to proximal fragment: Anterior, Posterior, Inferior, Superior

Slide 4

Acute Joint Dislocation Usually results from high-energy trauma They occur most frequently in young patients

Slide 5

Clinical Features Painful; inability to move the limb Abnormal shape of the joint The limb is often held in a characteristic position Careful NV exam before reduction is attempted.

Slide 6

Imaging X-rays adequate views Confirm the diagnosis Rule out fractures i.e. a fracture- dislocation Reduce before X-rays: knee, ankle CT scan

Slide 7

Treatment Urgent reduction: Closed; surgical if failed Adequate pain relief; muscle relaxant; GA Imaging after reduction: Post-reduction films Immobilization physiotherapy

Slide 8

Complications Neurovascular injury: Knee, ankle Avascular necrosis of bone Recurrent dislocation: shoulder Heterotopic ossification Joint stiffness Secondary osteoarthritis

Slide 9

ACUTE SHOULDER DISLOCATION The most commonly dislocating joint shallowness of the glenoid socket and wide extraordinary range of motion

Slide 10

ACUTE SHOULDER DISLOCATION Anterior dislocation is the most common Posterior dislocation is rare; less than 2%

Slide 11

ANTERIOR SHOULDER DISLOCATION Fall on the outstretched hand (abduction & external rotation)

Slide 12

ANTERIOR SHOULDER DISLOCATION The lateral outline of the shoulder may be flattened Bulge may be felt just below the clavicle

Slide 13

ANTERIOR SHOULDER DISLOCATION X-rays: antero-posterior and lateral (axillary) views: Overlapping shadows of the humeral head and glenoid fossa

Slide 14

ANTERIOR SHOULDER DISLOCATION The head usually lying below and medial to the socket Rule out greater tubrosity fracture

Slide 15

ANTERIOR SHOULDER DISLOCATION Avulsion of the antero-inferior glenoid labrum (Bankart lesion). Indentation of the postero-lateral part of the humeral head (HillSachs lesion)

Slide 16

ANTERIOR SHOULDER DISLOCATION Reduction Different techniques: Kochers, Stimsons, Milchs, Hippocratic

Slide 17

ANTERIOR SHOULDER DISLOCATION Reduction Kochers method

Slide 18

ANTERIOR SHOULDER DISLOCATION Complications Recurrent dislocation: age at first dislocation Rotator cuff tear: elderly Axillary nerve injury; neuropraxia Axillary artery injury Shoulder stiffness: prolonged immobilization Unreduced (undiagnosed) dislocation

Slide 19

POSTERIOR SHOULDER DISLOCATION Indirect force producing marked internal rotation and adduction Convulsion, or with an electric shock

Slide 20

POSTERIOR SHOULDER DISLOCATION The diagnosis is frequently missed; more than 50% The arm is held in internal rotation and is locked in that position The front of the shoulder looks flat with a prominent coracoid

Slide 21

POSTERIOR SHOULDER DISLOCATION Imaging The humeral head is medially rotated (electric light bulb) (The empty glenoid sign) Axillary or Scapular view is essential Rule out fractures; neck, glenoid or lesser tuberosity CT

Slide 22

HIP DISLOCATION High energy trauma posterior (the commonest) anterior

Slide 23

POSTERIOR HIP DISLOCATION Road Traffic accident; knee striking against the dashboard Limb is short, adducted, internally rotated and slightly flexed.

Slide 24

POSTERIOR HIP DISLOCATION Rule out associated fractures; femur or acetabulum Rule out sciatic nerve injury

Slide 25

POSTERIOR HIP DISLOCATION Reduction

Slide 26

POSTERIOR HIP DISLOCATION Reduction

Slide 27

POSTERIOR HIP DISLOCATION Reduction; stable CT scan: the best to demonstrate an acetabular fracture (or any bony fragment)

Slide 28

POSTERIOR HIP DISLOCATION Sciatic nerve injury; 10% Avascular necrosis of the femoral head ;10% If reduction is delayed by more than 12 hours, it rises to over 40% Hetrotopic ossification

Slide 29

ANTERIOR HIP DISLOCATION Rare compared with posterior The leg lies externally rotated, abducted and slightly flexed Palpable head in the groin

Slide 30

KNEE DISLOCATION High energy mechanism; RTA The cruciate ligaments and one or both lateral ligaments are torn

Slide 31

KNEE DISLOCATION If dislocated joint has reduced spontaneously; swelling and gross instability

Slide 32

KNEE DISLOCATION If still dislocated; gross deformity

Slide 33

KNEE DISLOCATION Repeated vascular examination is necessary; popliteal artery injury; risk compartment syndrome Common peroneal nerve injury: 20 % of cases

Slide 34

KNEE DISLOCATION X-ray: dislocation, fracture of the tibial spine (cruciate ligament avulsion), avulsion of the fibular styloid (collateral ligament avulsion)

Slide 35

KNEE DISLOCATION Angiograpy

Slide 36

KNEE DISLOCATION Urgent reduction Immediate vascular intervention if needed Acute or delayed reconstruction of the ligaments

Slide 37

KNEE DISLOCATION Complications Instability Stiffness

Slide 38

Summary Dislocation is an orthopedic emergency and need urgent reduction Anterior shoulder dislocation is the commonest Obtain adequate imaging to rule out posterior shoulder dislocation Acute unstable knee is a knee dislocation until proven otherwise Always suspect vascular injuries with dislocated knee