Dislocation occurs when a joint is displaced and the supporting ligaments and joint capsule are disrupted. There are different types including congenital, acquired, traumatic, and pathological dislocations. The most common joints that dislocate are the shoulder, hip, elbow, fingers, and cervical facet joints. Investigations include x-rays from different angles and sometimes CT scans. Management involves reducing acute dislocations promptly through closed reduction under anesthesia if possible to avoid complications like nerve damage, recurrent dislocations, and arthritis. Different techniques are used for reducing specific joints like the shoulder, hip, and fingers. Immobilization after reduction helps prevent recurrence.

1. DislocationMuhammad ShahiduzzamanProfessor & Head DepartmentOrthopaedic Surgery. DMC

2. DefinitionIt 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.

3. Types of dislocationCongenital AcquiredTraumaticPathological e.g. TB hip, Septic ArthritisParalytic e.g. Poliomyelitis, cerebral palsy, etcInflammatory disorders, rheumatoid arthritis,etc

4. DislocationNo joint is immune from dislocationMost commonly occur in the following joints. ShoulderHipElbowMetacarpophalengeal joint Facet joint dislocation in cervical spine.Acromiclavicular joint dislocation.

5. Typical deformities in dislocationShoulder- abduction deformitiesElbow- flexion deformitiesHip: Anterior- flexion abduction and internal rotation deformities.Posterior-flexion, adduction and internal rotation deformityKnee-flexion deformityAnkle-varus deformity

6. InvestigationsRadiograph of the affected part should include anterior posterior and lateral views and sometimes special views needed.CT Scan

7. Principles of managementAcute dislocation should be reduced as soon as possible.Open reduction is rarely necessary for acute dislocation.Close reduction with intravenous analgesia and sedation or under GA should be attempted first for most uncomplicated dislocation.

8. ComplicationAcute: Injury to peripheral nerve and vesselsChronic: Unreduced dislocation Recurrent dislocation Traumatic osteoarthritis Joint stiffness Avascular necrosis Myositis ossificans

9. Caution !Excessive force should not be used in close reduction. Forceful manipulation may lead to fracture.Interposition of soft tissue, bony fragment or buttonhole in capsule may make close reduction impossible.

10. Remember in DislocationIt is an orthopedic emergency.Reduction should be quick and prompt.Reduction should always be under G/A or sedation.Swelling is less in compared to fractures.Movements are more restricted than in fractures.

11. Remember in DislocationClosed reduction is sufficient in most of the times.Open reduction is restored to if specifically indicated.Reduction techniques should always be very gentle.Pain will not subside by splinting unlike fractures.

12. Shoulder DislocationTypes:Anterior dislocation: Varities of dislocations like Subcoracoid, subglenoid, sub-infraclavicular, inferior.Posterior Dislocation

13. Radiological ImagesAnterior Dislocation

14. Radiological ImagesAnterior dislocationOccurs with the arm held in abduction and external rotation.

15. Radiological ImagesPosterior DislocationCausesEpilepsyElectrocution

16. Reduction TechniquesStimson’s Gravity Method

17. Reduction TechniquesKOCHER’s Method

18. Reduction Techniques

19. After TreatmentThe arm should be fasten to the chest with a body bandage minimum period of three weeks.

20. Hip DislocationTypes:Posterior DislocationAnterior DislocationCenter Dislocation

21. Mechanism of Dislocation

22. Hip DislocationClinical Features:H/O Trauma

23. The patient has a flexion, adduction and medial rotational deformity of the affected limb.

24. Hip movement grossly restricted.Radiological ImagesHip dislocation

25. Hip DislocationReduction techniquesThe patient is supine on the floor under GA.The hip is flexed to 90 degree.Assistant stabilizing the pelvis.Longitudinal traction is applied.

26. Hip DislocationAfter TreatmentThe patient is put on surface traction for three weeks.Full weight bearing is permitted after 6 wks.

27. Elbow DislocationCommonly due to fall on outstretched hand.Closed reduction and long arm back slab for 3 wks is the treatment of choice.

28. MP Joint Dislocation

29. IP DislocationReduction Techniques..

30. Facet joint DislocationCommonest cervical spinal injury.May lead to quadriplegia.May be treated conservatively by Traction.May also need Open Reduction