JOINT DISLOCATIONSJOINT DISLOCATIONS

Dr.rudi febrianto Sp.OT

JOINT DISLOCATIONSJOINT DISLOCATIONS

DefinitionDefinition        A dislocation is a separation of two bones A dislocation is a separation of two bones

where they meet at a joint. A dislocated where they meet at a joint. A dislocated bone is no longer in its normal position. A bone is no longer in its normal position. A dislocation may also cause ligament or dislocation may also cause ligament or nerve damage. Dislocations may be nerve damage. Dislocations may be associated with a periarticular fractureassociated with a periarticular fracture

A subluxation is an incomplete or partialdislocation. For example, anursemaid's elbow is the subluxation of the head of the radius in the elbow.

SUBLUXATIONSUBLUXATION

DISLOCATION CAUSESDISLOCATION CAUSES

Dislocations are usually caused by a Dislocations are usually caused by a sudden impact to the joint. This sudden impact to the joint. This usually occurs following a blow, fall, usually occurs following a blow, fall, or other traumaor other trauma

Predisposing factor of Predisposing factor of dislocationdislocation

Susceptibility to fallSusceptibility to fall HeredityHeredity Sport participationSport participation Motor vehicle accidentMotor vehicle accident

DISLOCATION SYMPTOMSDISLOCATION SYMPTOMS

History of injuryHistory of injury Pain Pain SwellingSwelling Difficulty moving the jointDifficulty moving the joint Numbness and paresthesiasNumbness and paresthesias

DISLOCATION SIGNSDISLOCATION SIGNS

Visibly out-of-place, discolored, or misshapen joint

Limited joint movement Swollen or bruised Intensely painful, especially if you try

to use the joint or bear weight on it or move it.

Decreased sensation distal to the joint Decreased pulse, cool extremity distal

to the joint

NOMENCLATURE FOR NOMENCLATURE FOR DISLOCATIONSDISLOCATIONS

Name the Name the JOINTJOINT Name the dislocation by the position Name the dislocation by the position

of the of the DISTAL FRAGMENTDISTAL FRAGMENT in in relation to the proximal fragmentrelation to the proximal fragment

Add Add FRACTUREFRACTURE to the name if to the name if there is a periarticular fracture.there is a periarticular fracture.

Add Add OPENOPEN if a wound if a wound communicates with the dislocationcommunicates with the dislocation

RADIOGRAPHSRADIOGRAPHS

Two planes at 90 Two planes at 90 degrees to each degrees to each otherother

Good qualityGood quality Standard viewsStandard views See the entire jointSee the entire joint

Dislocated Elbow

TREATMENTTREATMENT

Reduce the dislocation as soon as Reduce the dislocation as soon as possiblepossible

Check Neurovascular function distallyCheck Neurovascular function distally Take post reduction radiographTake post reduction radiograph Immobilize the jointImmobilize the joint

REDUCTION TECHNIQUEREDUCTION TECHNIQUE

Start IVStart IV Give sedationGive sedation Apply traction forceApply traction force Manipulate jointManipulate joint

Posterior dislocation of Posterior dislocation of ElbowElbow

Fall on the hand with elbow slightly Fall on the hand with elbow slightly flexed or severe hyperextension injuryflexed or severe hyperextension injury

Clinical feature : humerus driven Clinical feature : humerus driven forward througt anterior capsule, there forward througt anterior capsule, there is always extensive soft tissue injury, is always extensive soft tissue injury,

Elbow is grossly swollen, olecranon is Elbow is grossly swollen, olecranon is readly palpable posteriorlyreadly palpable posteriorly

Complication : median nerve injury, Complication : median nerve injury, elbow stiffness, myositis ossificationelbow stiffness, myositis ossification

Reduction techniqueReduction technique

Reduction techniqueReduction technique

Shoulder dislocationShoulder dislocation

Anterior or posterior dislocationAnterior or posterior dislocation Shoulder joint is dependent stability Shoulder joint is dependent stability

on the joint capsule and surrounding on the joint capsule and surrounding musclemuscle

The glenoid cavity being small in The glenoid cavity being small in relation to head of humerusrelation to head of humerus

Anterior dislocation of Anterior dislocation of shouldershoulder

Incident is 95% of all dislocation of Incident is 95% of all dislocation of shouldershoulder

Caused by forced external rotation and Caused by forced external rotation and extension of shoulderextension of shoulder

Humeral head driven forward and Humeral head driven forward and frequently avulses the cartilagenous frequently avulses the cartilagenous glenoid labrum and capsule from anterior glenoid labrum and capsule from anterior margin of the glenoid cavitymargin of the glenoid cavityThe bankart The bankart lesionlesion

Patient immediately aware Patient immediately aware

TreatmentTreatment– prone position in 10 minute wait until prone position in 10 minute wait until

spontaneous reposition to normalspontaneous reposition to normal– Hippocrates techniqueHippocrates technique– Reduction with general anesthesia Reduction with general anesthesia

ComplicationComplication– RecurrentRecurrent– Traction injury of axillary nerveTraction injury of axillary nerve

SHOULDER REDUCTIONSHOULDER REDUCTION

SedationSedation Apply traction and Apply traction and

counter tractioncounter traction Lift humeral head Lift humeral head

into the glenoidinto the glenoid

Posterior dislocation of Posterior dislocation of shouldershoulder

posterior dislocation of the posterior dislocation of the hiphip

Dashboard injury or fall on the knee flexedDashboard injury or fall on the knee flexed Usually jeopardize blood supply to femoral Usually jeopardize blood supply to femoral

headheademergency and need to reduce as emergency and need to reduce as soon as possible to prevent avascular soon as possible to prevent avascular necrosisnecrosis

To lower incident of avascular necrosis To lower incident of avascular necrosis need to be reduced in first 8 hoursneed to be reduced in first 8 hours

Clinical feature : hip in flexion, adduction, Clinical feature : hip in flexion, adduction, internal rotation and shortening internal rotation and shortening

X-ray : femoral head lies well above the X-ray : femoral head lies well above the acetabulumacetabulum

Hip reductionHip reduction

Hip reductionHip reduction

HIP REDUCTIONHIP REDUCTION

SedationSedation Relaxation, Relaxation,

flexion, traction, flexion, traction, and rotationand rotation

Gentle and Gentle and atraumaticatraumatic

Relocation should be palpable and permit significantly improved ROM. This often requires very deep sedation.

Anterior dislocation of the Anterior dislocation of the hiphip

Ankle dislocationAnkle dislocation

PIPJ DISLOCATIONPIPJ DISLOCATION

Hyper-extend the joint, apply traction then flex the joint. Follow with a post reduction x-ray, check for avulsion fracture.

THANK YOU