1. Major joint dislocations – Hip
, shoulder & knee

2. 3 true orthopaedics emergencies
• Dislocation
• Fracture associated with limb threatening vascular injury
• Compartment syndrome

3. Dislocation
• An injury where bones forming a joint are pushed out of normal
position
• Post traumatic / congenital
• Recurrent dislocations

4. General approach to dislocation
• Pain / deformity / restriction of movement
• History ( mechanism of injury , previous dislocations, comorbidities )
• ABC
• Deformity/ skin / tenderness / restriction of movement / neurovascular
injuries
• Plain Xray of affected joint ( confirm diagnosis / direction of dislocation /
associated fractures / quality of bone )

5. • Temporary immobilization of limb for pain relief
• Plan for closed reduction and splinting
• Post reduction x ray documentation
- concentrically reduced joint
- iatrogenic fractures
- medicolegal purpose
• Duration of immobilization
• Rehabilitation plan

6. Shoulder dislocation
• Most common joint dislocation ( 50 %)
• Anatomically unstable joint
• Classified
1. anterior ( 90%)
-
2. posterior
3. inferior ( luxation erecta )

8. Duga test Hamilton rulter test

9. Callaway test Bryant test
• Affected side axillary fold
appears elongated

10. Axillary nerve function – regiment patch
anaesthesia

11. Xray – AP/ scapula y view / axillary lateral
view

12. Axillary view

13. Scapula Y view

14. Associated # ( GT , neck of humerus )

15. Kocher method

16. Hippocratic method

17. Stimson technique

18. Rehabilitation
• 2 weeks of immobilization
• Check xray after 2 weeks
• Escalating joint ROM and muscle
strengthening exercises
• Avoid Abd / ext rot

19. Posterior dislocation shoulder
• Electrocution / epilepsy
• Easily missed by clinician
- lack of gross deformity
- confusing xray finding

21. Axillary lateral view Scapula Y view

22. Inferior dislocation – luxatio erecta