Joint dislocations

1. Joint Dislocations
Richard Hay
with minor assistance from James Wheeler

2. Shoulder Dislocations

8. Types of Dislocation
• Anterior - subcoracoid (60%)

11. Types of Dislocation
• Anterior - subcoracoid (60%)
• Anteroinferior - subglenoid (30%)

14. Types of Dislocation
• Anterior - subcoracoid (60%)
• Anteroinferior - subglenoid (30%)
• Posterior (4-10%)

16. Types of Dislocation
• Anterior - subcoracoid (60%)
• Anteroinferior - subglenoid (30%)
• Posterior (4-10%)
• Laxation erecta - true inferior

17. Luxatio Erecta
inferior glenohumeral dislocation

19. Shoulder reduction techniques

20. General Principles
• Relocation prevented by
• Static forces
• Joint capsule / lip of glenoid
• Dynamic forces
• Rotator cuff
• Biceps
• Trapezius / deltoid
• Pectoralis

21. General Principles
• Alignment
• Scapula and humeral head
• Zero position
• combination of external rotation and
abduction
• Relaxation

22. 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)

23. Hip Dislocation

24. 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

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

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

27. 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

29. Ankle dislocations

32. 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

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

36. Knee dislocation
• High force injury
• Associated injuries