The document discusses shoulder and hip dislocations. It notes that shoulder dislocations are more common and involve instability, while hip dislocations typically result from high-energy injuries. For both joints, anatomic reduction through appropriate maneuvers is important, along with assessing neurovascular status and immobilization. Complications can include associated fractures, non-reduction, and neurovascular deficits. Selecting reduction techniques that are rapid, safe and effective is ideal.

1. Presenter: Dr.Tumsa(OSR-II)
Moderator: Dr.Ayetenew(ECCM Specialist)

2.  50% of large joints
 Inherently unstable
 Allows tremendous range of activities
 Stability: static and dynamic structures

4.  Static stability: capsule,ligaments,labrum and
bony arthiculation

5.  Dynamic stability

6.  95-97%
 Indirect:abduction,extension &ER,FOOSH
 Direct: AP thrust
 3 subtypes

7.  Arm held in abducted,external rotated
 Lost contours,limited range of motions

8.  AP,scapular and lateral axillary xray series

9.  2-4%
 Direct AP impact
 Indirect forces to adducted,IR
arm(seizure,electrocution,FOOSH)
 Arm is abducted,IR w/out loss of shoulder
contour
 Often missed!

10.  AP sighns
olight bulb
oIR of head
owidening of joint…rim

11.  Bankart lesion(80-90%)-
anteroinferior labrum& IGHL
 Hill sacks(80%)-posterosuperior head
impaction injury
 Bony bankart lesion
 GT & LT #s
 Rotator cuff tears-40% of >40yrs
 Axillary nerve neurapraxia(5%)

12.  Perform & document neurovascular exam
 Scrutinize radiography & identify contraindications
ohumeral neck #
 Strong analgesia or procedural sedation as needed
 Maneuvers employ: traction,leverage,scapular
manipulation or combinations
 Method of reduction
orapid,safe & effective

13.  Method:literature review in Pubmed & google
scholar database
 8 methods were compared: efficacy,reduction time
& pain(VAS)
 The manuevers: Scapular Manipulation, Matsen’s
Traction-Countertraction, Kocher’s, Spaso, External
Rotation, Cunningham, Modified Milch, and the
FARES
 Results:traction-counter traction,highest efficacy
Scapular manipulation,least VAS score
FARES method,fastest reduction time

16.  grasp hand
 Elbow extended,midprone
 Longitudinal traction
 Vertical oscillations
 Go on with abduction
 ER at 90degrees of abduction
 Keep on till 120degrees

17.  Ascertain stability,re-exam NV status,control xray
 Immobilize(broad arm sling)
o2wks if >40, 3-6wks in the young
 Obtain Orthopeadic consultation
oAss’d injuries
o Irreducilities,unstable reduction
o Post reduction NV deficit
o Reccurent dislocation-failed
o

18.  Inherently stable
 Ball & socket,head is 2/3rd spherical
 Labrum adds to 10% depth,50% coverage
 Dynamic stability: much of the stability

19.  Static stability: bones,labrum,ligaments

22.  90% of the cases; 9:1 occurance
 MOI: deceleration with knee strike
 P/E: flexed,IR & adducted hip

23.  Flexed/extended,IR & hyperabducted
 2 subtypes: superior/pubic,inferior/obterator

24.  95% of posterior ones
 Systemic:Chest,Abdomen,head
 Orthopedic: knee,femor,acetabulum,spine
o Sciatic nerve(10-20%)
ATLS approach,spinal precautions

25.  ABCDE of life!
 Examine and document NV status
 Beware of contraindications:
oFemoral neck fracture
oUnstable pelvic fracture
 Early and congruent reduction is key
 Successful reduction:
oadeqaute paralysis-GA
o continous nonjerky traction & gentle
manipulation

26.  Posterior dislocation: traction,IR & adduction
 Anterior dislocation: inline traction,ER with lateral
pushing femoral head laterally
 Allis Maneuver

27.  Inline traction,ER flexion/extension with lateral
pushing femoral head laterally

28.  Grasp ankle with aonther hand under knee
 Flex,ER and longitudinal traction
 Assistant counteracting at pelvis

29.  Makes use of Allis & Bigelow manuevers
 Minimises lumbar muscles strain to Physician

30.  Ensure stability with ER & IR at both
flexion,extension
 Re-do NV exam and document
 Immobilize in the mid of safe arc
 Obtain post reduction CT scan
 Provide tips: precautions,exercises
 Protected weight bearing/4-6wks

31.  Irreducible dislocation
 Radiologic incarcerated fragment
 Non-concentric reduction
 Associated injuries
 Postreduction NV deficit
 Delayed presentation

33.  Shoulder is inherently unstable,50% dislocate
 Hip is inherently stable-high energy injury
 Ideal reduction manuever: rapid,safe & effective
 Pay attention to pre& post reduction images detail
 Timely,anatomic reduction affects outcome
 Obtain interdisciplinary opinion as needed

34.  Rockwood & Green’s Fractures in Adults,9th ed
 Ochsner Journal 18:242–252, 2018 ©
 Orthopedic Reviews 2016; volume 8:6253
 International Journal of Medical Research and
Review;2020 Volume 8 Number 2 March-April
 Orthobullets 2023