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Dislocation<br />Muhammad Shahiduzzaman<br />Professor & Head Department<br />Orthopaedic Surgery.  DMC<br />
Definition<br />It is complete and persistent displacement of a joint in which at least part of the supporting joint capsu...
Types of dislocation<br />Congenital <br />Acquired<br />Traumatic<br />Pathological  e.g. TB hip, Septic Arthritis<br />P...
Dislocation<br />No joint is immune from dislocation<br />Most commonly occur in the following joints. <br />Shoulder<br /...
Typical deformities in dislocation<br />Shoulder- abduction deformities<br />Elbow- flexion deformities<br />Hip: <br />An...
Investigations<br />Radiograph of the affected part should include anterior posterior and lateral views and sometimes spec...
Principles of management<br />Acute dislocation should be reduced as soon as possible.<br />Open reduction is rarely neces...
Complication<br />Acute: Injury to peripheral nerve and vessels<br />Chronic: Unreduced dislocation<br />			Recurrent disl...
Caution !<br />Excessive force should not be used in close reduction. <br />Forceful manipulation may lead to fracture.<br...
Remember in Dislocation<br />It is an orthopedic emergency.<br />Reduction should be quick and prompt.<br />Reduction shou...
Remember in Dislocation<br />Closed reduction is sufficient in most of the times.<br />Open reduction is restored to if sp...
Shoulder Dislocation<br />Types:<br />Anterior dislocation: Varities of dislocations like Subcoracoid, subglenoid, sub-inf...
Radiological ImagesAnterior Dislocation<br />
Radiological ImagesAnterior dislocation<br />Occurs with the arm held in abduction and external rotation.<br />
Radiological ImagesPosterior Dislocation<br />Causes<br />Epilepsy<br />Electrocution<br />
Reduction Techniques<br />Stimson’s Gravity Method<br />
Reduction Techniques<br />KOCHER’s Method<br />
Reduction Techniques<br />
After Treatment<br />The arm should be fasten to the chest with a body bandage minimum period of three weeks.<br />
Hip Dislocation<br />Types:<br />Posterior Dislocation<br />Anterior Dislocation<br />Center Dislocation<br />
Mechanism of Dislocation<br />
Hip Dislocation<br />Clinical Features:<br /><ul><li>H/O Trauma
The patient has a flexion, adduction and medial rotational deformity of the affected limb.
Hip movement grossly restricted.</li></li></ul><li>Radiological ImagesHip dislocation<br />
Hip DislocationReduction techniques<br />The patient is supine on the floor under GA.<br />The hip is flexed to 90 degree....
Hip DislocationAfter Treatment<br />The patient is put on surface traction for three weeks.<br />Full weight bearing is pe...
Elbow Dislocation<br />Commonly due to fall on outstretched hand.<br />Closed reduction and long arm back slab for 3 wks i...
MP Joint Dislocation<br />
IP Dislocation<br />Reduction Techniques..<br />
Facet joint Dislocation<br />Commonest cervical spinal injury.<br />May lead to quadriplegia.<br />May be treated conserva...
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Dislocation

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Undergraduate lecture class by renowned Professor of Orthopaedics, Prof. Muhammad Shahiduzzaman.

Dislocation

  1. 1. Dislocation<br />Muhammad Shahiduzzaman<br />Professor & Head Department<br />Orthopaedic Surgery. DMC<br />
  2. 2. Definition<br />It is complete and persistent displacement of a joint in which at least part of the supporting joint capsule and some of its ligaments are disrupted. <br />
  3. 3. Types of dislocation<br />Congenital <br />Acquired<br />Traumatic<br />Pathological e.g. TB hip, Septic Arthritis<br />Paralytic e.g. Poliomyelitis, cerebral palsy, etc<br />Inflammatory disorders, rheumatoid arthritis,etc<br />
  4. 4. Dislocation<br />No joint is immune from dislocation<br />Most commonly occur in the following joints. <br />Shoulder<br />Hip<br />Elbow<br />Metacarpophalengeal joint <br />Facet joint dislocation in cervical spine.<br />Acromiclavicular joint dislocation.<br />
  5. 5. Typical deformities in dislocation<br />Shoulder- abduction deformities<br />Elbow- flexion deformities<br />Hip: <br />Anterior- flexion abduction and internal rotation deformities.<br />Posterior-flexion, adduction and internal rotation deformity<br />Knee-flexion deformity<br />Ankle-varus deformity<br />
  6. 6. Investigations<br />Radiograph of the affected part should include anterior posterior and lateral views and sometimes special views needed.<br />CT Scan<br />
  7. 7. Principles of management<br />Acute dislocation should be reduced as soon as possible.<br />Open reduction is rarely necessary for acute dislocation.<br />Close reduction with intravenous analgesia and sedation or under GA should be attempted first for most uncomplicated dislocation.<br />
  8. 8. Complication<br />Acute: Injury to peripheral nerve and vessels<br />Chronic: Unreduced dislocation<br /> Recurrent dislocation<br /> Traumatic osteoarthritis<br /> Joint stiffness<br /> Avascular necrosis<br /> Myositis ossificans<br />
  9. 9. Caution !<br />Excessive force should not be used in close reduction. <br />Forceful manipulation may lead to fracture.<br />Interposition of soft tissue, bony fragment or buttonhole in capsule may make close reduction impossible.<br />
  10. 10. Remember in Dislocation<br />It is an orthopedic emergency.<br />Reduction should be quick and prompt.<br />Reduction should always be under G/A or sedation.<br />Swelling is less in compared to fractures.<br />Movements are more restricted than in fractures.<br />
  11. 11. Remember in Dislocation<br />Closed reduction is sufficient in most of the times.<br />Open reduction is restored to if specifically indicated.<br />Reduction techniques should always be very gentle.<br />Pain will not subside by splinting unlike fractures.<br />
  12. 12. Shoulder Dislocation<br />Types:<br />Anterior dislocation: Varities of dislocations like Subcoracoid, subglenoid, sub-infraclavicular, inferior.<br />Posterior Dislocation<br />
  13. 13. Radiological ImagesAnterior Dislocation<br />
  14. 14. Radiological ImagesAnterior dislocation<br />Occurs with the arm held in abduction and external rotation.<br />
  15. 15. Radiological ImagesPosterior Dislocation<br />Causes<br />Epilepsy<br />Electrocution<br />
  16. 16. Reduction Techniques<br />Stimson’s Gravity Method<br />
  17. 17. Reduction Techniques<br />KOCHER’s Method<br />
  18. 18. Reduction Techniques<br />
  19. 19. After Treatment<br />The arm should be fasten to the chest with a body bandage minimum period of three weeks.<br />
  20. 20. Hip Dislocation<br />Types:<br />Posterior Dislocation<br />Anterior Dislocation<br />Center Dislocation<br />
  21. 21. Mechanism of Dislocation<br />
  22. 22. Hip Dislocation<br />Clinical Features:<br /><ul><li>H/O Trauma
  23. 23. The patient has a flexion, adduction and medial rotational deformity of the affected limb.
  24. 24. Hip movement grossly restricted.</li></li></ul><li>Radiological ImagesHip dislocation<br />
  25. 25. Hip DislocationReduction techniques<br />The patient is supine on the floor under GA.<br />The hip is flexed to 90 degree.<br />Assistant stabilizing the pelvis.<br />Longitudinal traction is applied.<br />
  26. 26. Hip DislocationAfter Treatment<br />The patient is put on surface traction for three weeks.<br />Full weight bearing is permitted after 6 wks.<br />
  27. 27. Elbow Dislocation<br />Commonly due to fall on outstretched hand.<br />Closed reduction and long arm back slab for 3 wks is the treatment of choice.<br />
  28. 28. MP Joint Dislocation<br />
  29. 29. IP Dislocation<br />Reduction Techniques..<br />
  30. 30. Facet joint Dislocation<br />Commonest cervical spinal injury.<br />May lead to quadriplegia.<br />May be treated conservatively by Traction.<br />May also need Open Reduction<br />
  31. 31. Thank you for your attention.<br />

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