Dislocations And Fractures Of Bones

1. Dislocations
Dr Massam
1

2. Objectives
At the end of this session, students are expected
to be able to:
• Define dislocation
• Identify causes and risk factors
• Describe the different types of dislocations.
• Describe clinical features
• Identify the investigations
• Describe the management of dislocations
• Identify the complications of dislocations.

3. Introduction
• A dislocation is a total disruption of joint with
no remaining contact between the articular
surfaces.
–That is the articular surfaces are no longer
in full or correct contact

4. Introduction cont..
• Dislocations can be complete or partial.
–In a complete dislocation, the joint surfaces
are completely separated.
– In a partial dislocation, the joint surfaces
are only partly separated (sublaxation)

5. Causes
• Congenital
• Acquired
–Traumatic
–Pathological e.g. TB hip, Septic Arthritis
–Paralytic e.g. Poliomyelitis, cerebral palsy,
etc
–Inflammatory disorders, rheumatoid
arthritis,etc

6. Causes :traumatic
From direct Trauma
• High Energy trauma
→Road traffic accident
→ Fall from Heights
→ Sports injuries
→ Industrial injuries
• Low Energy Trauma
→ Sports injuries
From indirect Trauma
– Varus, Valgus and
rotational stress

7. Types of dislocation
• Traumatic dislocations
–A force strong enough to disrupt the joint
capsule and dislocates a previously normal
joint.
• Pathological /Spontaneous dislocation
–Occurs when underlying pathological
condition in the joint causes abnormality in
the structural integrity of the joint. e.g.
Septic hip dislocation

8. Types of dislocation cont..
• Recurrent dislocation
–This is a dislocation which occurs
repeatedly after trivial injuries due to
weakening of the supportive joint structures
• Congenital dislocation
–A type of dislocation which is present
congenitally since birth. E.g. Congenital hip
dislocation

9. Types of dislocation cont..
According to the direction
• Anterior
• Anteroinferior
• Posterior
• Laxation erecta - true inferior
• medial/lateral

10. Common sites
• No joint is immune from dislocation
• The most commonly dislocated is the shoulder
joint
• Elbow: Posterior dislocation, 90% of all elbow
dislocations
• Wrist: Lunate and Perilunate dislocation most
common

11. Common sites cont..
• Finger: Interphalangeal (IP) or
metacarpophalangeal (MCP) joint dislocations
• Hip: Posterior and anterior dislocation of hip

12. Clinical features
On history
• Deformity or abnormal appearance
• Pain and tenderness aggravated by movement
• Loss of normal function
• Joint may be locked in one position
• Swelling of the joint

13. Clinical features cont..
On Physical examination:
• Shoulder dislocation:
–Arm in a characteristic position of external
rotation and slight abduction
–Fullness anteroinferior to the coracoid
process is palpable

14. Clinical features cont..
• Elbow dislocation:
–elbow held in flexion
–significant amount of soft tissue swelling
around the elbow
• Finger dislocation:
–oedema and ecchymosis (bruising)

15. Clinical features cont..
• Patellar dislocation
–swollen knee held in flexion and no obvious
lateral prominence
–often associated with haemarthrosis
(bleeding into joint spaces)

16. Clinical features cont..
• Hip dislocation:
–Posterior hip dislocation is with the hip in a
position of flexion, internal rotation, and
adduction
–Anterior hip dislocations, the hip is
classically held in external rotation, with
mild flexion and abduction.

17. Typical deformities in dislocation
• Shoulder- abduction deformities
• Elbow- flexion deformities
• Hip:
– Anterior- flexion abduction and internal rotation
deformities.
– Posterior-flexion, adduction and internal rotation
deformity
• Knee-flexion deformity
• Ankle-varus deformity

18. Investigations
• X-ray of the affected part should include
anterior posterior and lateral views and
sometimes special views needed.
• CT Scan
• MRI

19. Principles of management
• Is an Emergency
• It should be reduced in less than 24 hours or
there may be Avascular Necrosis and joint
stiffness
• Following reduction the limb should be
immobilized for several weeks.

20. Principles of management cont..
• Close reduction with intravenous analgesia and
sedation or under GA should be attempted first
for most uncomplicated dislocation.
• Open reduction is rarely necessary for acute
dislocation.

21. Reduction techniques
• Hippocrates Method ( A form of anesthesia or
pain abolishing is required )
• Stimpson’s technique ( some sedation and
analgesia are used but No anesthesia is required )
• Kocher’s technique is the method used in
hospitals under general anesthesia and muscle
relaxation
NOTE
• No single best technique

25. Complications
• Acute: Injury to peripheral nerve and vessels
• Chronic: Unreduced dislocation
–Recurrent dislocation
–Traumatic osteoarthritis
–Joint stiffness
–Avascular necrosis
–Myositis ossificans

26. Key points
• It 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

27. Key points cont..
• Closed 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

28. Review questions
1. What is dislocation?
2. Mention are the causes of dislocations?
3. Describe the complications of dislocations.
28

29. References
• Sam W. Wiesel, John N. Delahay : Essentials
of Orthopedic Surgery, Third Edition
• T Duckworth, C M blundell : Lecture Notes
On Orthopedics And Fracture.
• Apley's concise system of orthopedics and
fracture
• Medscape