Joint DislocationsRichard Hay

with minor assistance from James Wheeler

Shoulder Dislocations

Types of Dislocation

• Anterior - subcoracoid (60%)

Types of Dislocation

• Anterior - subcoracoid (60%)• Anteroinferior - subglenoid (30%)

Types of Dislocation

• Anterior - subcoracoid (60%)• Anteroinferior - subglenoid (30%)• Posterior (4-10%)

Types of Dislocation

• Anterior - subcoracoid (60%)• Anteroinferior - subglenoid (30%)• Posterior (4-10%)• Laxation erecta - true inferior

Luxatio Erecta inferior glenohumeral dislocation

Shoulder reduction techniques

General Principles

• Relocation prevented by• Static forces• Joint capsule / lip of glenoid

• Dynamic forces• Rotator cuff• Biceps• Trapezius / deltoid• Pectoralis

General Principles

• Alignment• Scapula and humeral head• Zero position• combination of external rotation and

abduction• Relaxation

Reduction techniques• No single best technique• Hippocratic• Kocher’s• Matsen’s traction countertraction• Milch • Stimson’s • Scapular rotation• Cunningham• Spaso• Mane’s• Self rescue (Boss-Holzach-Matter)

Hip Dislocation

Types of Dislocation• Posterior (90%)• Axial load in flexed adducted hip• Position• Flexion / adduction / internal rotation

• Anterior• Load on abducted externally rotated hip• Hip in extension - superior

• XR - larger femoral head / lesser trochanter more visible

• Hip in flexion - inferior• Position• Flexion / abduction / external rotation

• Case courtesy of Dr Sajoscha Sorrentino, Radiopaedia.org, rID: 14836

• Case courtesy of Dr Sajoscha Sorrentino, Radiopaedia.org, rID: 14836

Reduction• Within 6hrs• Patient supine• Adequate sedation• Posterior dislocation• Stabilise pelvis• Axial traction• Flex hip to 90 deg flexion, external rotation, extension and abduction

• Anterior dislocation• Axial traction• Flex hip and knee to 90 deg, internal rotation, extension and adduction

• CT post reduction

Ankle dislocations

Knee dislocation• Use position of tibia as reference• Anterior (most common)• Hyperextension

• Posterior• Force to anterior tibia with knee flexed

• Medial / lateral / rotational• Valgus / varus / rotational forces

Elbow dislocation• 2nd most common large jt dislocation• Simple / complex• Radial head #• Coronoid #

• Terrible triad

Knee dislocation

• High force injury• Associated injuries