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MUHAMMAD FARRUKH BASHIR
DISLOCATIONS AND TREATMENT MUHAMMAD FARRUKH BASHIR FCPS (ORTHO)
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JOINTS AC JOINT SHOULDER ELBOW KNEE HIP ANKLE
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SHOULDER ANATOMY
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Pathoanatomy HILL SACHS LESION BANKART LESION
POSTEROLATERAL HEAD DEFECT BANKART LESION AVULSION OF ANTEROINFERIOR LABRUM
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CLINICAL EVALUATION Prominent acromion, sulcus sign, palpable humeral head anteriorly Intense pain.
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Types Anterior ..most common. Posterior..(epileptic .electric shock)
Superior Subcoracoid
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Investigation AP Axillary Special Views:
West Point axillary: for visualization of glenoid rim Hill-Sach view: internal rotation view Stryker Notch: view 90% of posterolateral humeral head
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Reduction Under proper analgesia Most Common Techniques
Kocher (71-100%) External Rotation (78-90%) Milch (70-89%) Stimson (91-96%) Traction/Countertraction Scapular Manipulation (79-96%) Under proper analgesia
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contd Kocher Arm is adducted and flexed at the elbow
Externally rotate arm until resistance is felt The ER arm is flexed forward as far as possible The arm is internally rotated
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Post reduction Only 2-3 weeks immoblization
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HIP DISLOCTION
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TYPES OF IP DISLOCATIONS
POSTERIOR.MOST COMMON ANTERIOR. SUPERIOR INFERIOR
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Clinical Post :internally rotated shortened limb
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Thompson and Epstein Classification of Hip Dislocations
Type I Pure dislocation with at most a small wall fragment. Type II Dislocation with large posterior wall fragment. Type III Dislocation with comminuted posterior wall. Type IV Dislocation with “acetabular floor” fracture (probably transverse + post. wall acetabulum fracture-dislocation). Type V Dislocation with femoral head fracture.
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Investigation X rays; AP LATERAL CT SCAN
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REDUCTION ALLIS EAST BALTIMORE STIMSON Open reduction
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Post reduction Immoblize for 2-3 weeks.
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Elbow dislocation
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Terrible triad Elbow dislocation+radial head Fx+coronoid Fx+lateral colleteral ligament tear
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Types
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X ays AP LATERAL Ct scan
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Reducton Close Open If unstale:
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Post reduction Immoblize 2-3 weeks Start ROM as early as possible….
Elbow notorious for adhesion.
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