Major joint dislocations include the hip, shoulder, and knee. Dislocations involve bones being pushed out of their normal position in the joint. The general approach involves assessing pain, deformity, range of motion, history of injury, and getting x-rays to confirm and check for fractures. Reduction methods are used to put the bones back in place, followed by immobilization and rehabilitation exercises. Shoulder dislocations are most common and can be anterior, posterior, or inferior types. Assessment includes specific tests and x-rays views to identify type and check for other injuries before selecting a reduction technique.

1. Major joint dislocations – Hip
, shoulder & knee

2. 3 true orthopaedics emergencies
• Dislocation
• Fracture associated with limb threatening vascular injury
• Compartment syndrome

3. Dislocation
• An injury where bones forming a joint are pushed out of normal
position
• Post traumatic / congenital
• Recurrent dislocations

4. General approach to dislocation
• Pain / deformity / restriction of movement
• History ( mechanism of injury , previous dislocations, comorbidities )
• ABC
• Deformity/ skin / tenderness / restriction of movement / neurovascular
injuries
• Plain Xray of affected joint ( confirm diagnosis / direction of dislocation /
associated fractures / quality of bone )

5. • Temporary immobilization of limb for pain relief
• Plan for closed reduction and splinting
• Post reduction x ray documentation
- concentrically reduced joint
- iatrogenic fractures
- medicolegal purpose
• Duration of immobilization
• Rehabilitation plan

6. Shoulder dislocation
• Most common joint dislocation ( 50 %)
• Anatomically unstable joint
• Classified
1. anterior ( 90%)
-
2. posterior
3. inferior ( luxation erecta )

8. Duga test Hamilton rulter test

9. Callaway test Bryant test
• Affected side axillary fold
appears elongated

10. Axillary nerve function – regiment patch
anaesthesia

11. Xray – AP/ scapula y view / axillary lateral
view

12. Axillary view

13. Scapula Y view

14. Associated # ( GT , neck of humerus )

15. Kocher method

16. Hippocratic method

17. Stimson technique

18. Rehabilitation
• 2 weeks of immobilization
• Check xray after 2 weeks
• Escalating joint ROM and muscle
strengthening exercises
• Avoid Abd / ext rot

19. Posterior dislocation shoulder
• Electrocution / epilepsy
• Easily missed by clinician
- lack of gross deformity
- confusing xray finding

21. Axillary lateral view Scapula Y view

22. Inferior dislocation – luxatio erecta