TRAUMATIC
DISLOCATION
Definition
• Complete loss of
CONGRUENCY between
the two articulating
surfaces of a joint.
• Incomplete dislocation=
subluxation
Types
• Congenital: Congenital dislocation of hip
• Pathological: - polio
- infection
• Traumatic: tear of ligaments and capsule
Clinical picture
➢ Severe pain
➢ Loss of movements
➢ Abnormal position of the limb
i.e. deformity
➢ Altered bony landmarks
Treatment
✓ Urgent reduction : Under
General/Regional Anesthesia
✓ Splintage( fixation )
Complications
Nerve injuries: Shoulder-Axillary Nerve
Hip-Sciatic Nerve
• Vascular injuries
• Chronic dislocation
• Recurrent dislocations : ( M/C in shoulder)
• Avascular Necrosis
• Osteoarthritis
• Joint stiffness :
- adhesions
- myositis ossificans
Dislocations of specific
joints
❖ Shoulder
❖ Elbow
❖ Hip
Shoulder Dislocation
❑ It is the most
commonly affected
joint (almost half of
all dislocations).
❑ It is due to :
▪ Wide range of movements
▪ Shallow glenoid
▪ Weak capsule/ligament
❑ Usually anterior
dislocation in 90% cases.
Shoulder Dislocation
Types : -
[Link]
➢ Subcoracoid
➢ Subglenoid
➢ Subclavicular
➢ Infrathoracic
2. Posterior
[Link]
ANTERIOR SHOULDER DISLOCATION
➢ Mechanism of Injury : Most common
mechanism of injury is fall on outstretched
hand.
Clinical picture
✓ Severe pain and loss of
movements
✓ Arm abducted
✓ Holds arm with other arm closed to
the trunk of the body
✓ Loss of rounded contour of the
shoulder causing squared off
appearance
✓ Prominent acromion
✓ Humeral head located sub-
coracoid .
✓ Axillary nerve palsy results in
numbness in regimental
badge area.
XRAY
Treatment
• Urgent closed
reduction under
General
Anaesthesia
• Strapping:
Post Reduction
• to allow healing of the
torn labrum and capsule.
Reduction techniques
1. Kochers method
2. Hippocrates Method
3. Milch’s Method
4. Stimson’s technique
Complications
• Neuro -vascular injuries: Axillary Nerve and
Axillary Artery
• Recurrent anterior dislocation of the shoulder.
Avascular necrosis of head of humerus.
• Bony Lesions: Bankart’s (Persistent
avulsion of the labrum in anterioinferior
part and Hill Sach’s Lesion (A
posterolateral head defect is caused by
an impression fracture on the glenoid
rim)
Posterior Dislocation of
Shoulder
• 5-10% of shoulder dislocations
• Shoulder is in adduction flexion and internal rotation
Mechanism Of Injury:-
Indirect
◦ Electric shock
◦ Seizure episode
Direct
◦ Force on the anterior shoulder
The patient is not able to demonstrate any
external rotation.
XRAY
ON AP view of the shoulder the light bulb
sign indicates the full internal rotation of
the humeral head with loss of normal
contour greater tuberosity.
Treatment-Closed Reduction
• Traction to adduct arm in the
line of deformity
• Gentle lifting of humeral head
into the glenoid fossa
Complications
❑ Neurological
❑ Axillary
❑ Nerve to infraspinatus
❑ Vascular
❑ Fractures Recurrence
Inferior Dislocation
Luxatio erecta
Mechanism
Hyperabduction force
Clinical Features
Very characteristic Salute
Sign of highly abducted and
forward position and the
patient is unable to adduct the
shoulder.
Radiograph
Reduction
Traction is performed
in the line of the
abducted limb with a
sheet around the
patient’s chest
providing counter
traction then the arm is
gradually adducted.
Complications
High
◦ Vascular
◦ Neurological
◦ Ligaments
◦ Fractures
Dislocation of the Elbow
Types Types
• Usually posterior :
with or without from • Simple :without a
coronoid.
fracture
• Rarely anterior :
with from olecranon.
• Complex:with a
• Sometimes lateral or fracture
medial.
Mechanism Of
Injury:
-Fall on outstretched hand most
common.
Signs and
Symptoms
• Pain, loss of movements
• Deformity around elbow
and usually held in near
extension.
• Altered bony landmarks
i.e. the equilateral
triangle of the elbow is
disrupted.
XRAY
Treatment
• Reduction under general anesthesia
• Splintage : by posterior above elbow slab
REDUCTION TECHNIQUES
COMPLICATIONS
• Neurovascular Injury
• Compartment Syndrome
• Stiffness
• Myositis ossificans
• Redislocation
Dislocation of the Hip
TYPES:
• Usually posterior : due
to high energy trauma
to flexed hip & knee
[dash-board accidents].
• Anterior dislocation :
very rare.
• Central dislocation :
associated with
fracture of
acetabulum.
Clinical picture of posterior
dislocation of hip
• Severe pain & loss
of movements.
• Flexion, adduction,
internal rotation and
shortening of the
affected limb.
• Femoral head felt in
the gluteal region.
• Femoral pulse may be
absent.
XRAY
Treatment
• urgent reduction under
anaesthesia
• splintage [ skin/skeletal
traction ]
REDUCTION TECHNIQUES
EAST BALTIMORE LIFT TECHNIQUE
ANTERIOR DISLOCATION OF HIP
The hip is minimally flexed, externally rotated
and markedly abducted.
CENTRAL DISLOCATION OF HIP
ALWAYS FRACTURE DISLOCATION
Complications
Early :
Sciatic nerve injury
Femoral nerve injury
Late :
Avascular necrosis of the
femoral head, leading to
osteoarthritis of the hip .