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

1. Dislocation Muhammad Shahiduzzaman Professor & Head Department Orthopaedic Surgery. DMC

2. Definition 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.

3. Types of dislocation Congenital Acquired Traumatic Pathological e.g. TB hip, Septic Arthritis Paralytic e.g. Poliomyelitis, cerebral palsy, etc Inflammatory disorders, rheumatoid arthritis,etc

4. Dislocation No joint is immune from dislocation Most commonly occur in the following joints. Shoulder Hip Elbow Metacarpophalengeal joint Facet joint dislocation in cervical spine. Acromiclavicular joint dislocation.

5. 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

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

7. Principles of management Acute 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. Complication Acute: Injury to peripheral nerve and vessels Chronic: 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 Dislocation 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.

11. Remember in Dislocation 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.

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

13. Radiological ImagesAnterior Dislocation

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

15. Radiological ImagesPosterior Dislocation Causes Epilepsy Electrocution

16. Reduction Techniques Stimson’s Gravity Method

17. Reduction Techniques KOCHER’s Method

18. Reduction Techniques

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

20. Hip Dislocation Types: Posterior Dislocation Anterior Dislocation Center Dislocation

21. Mechanism of Dislocation

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

25. Hip DislocationReduction techniques The 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 Treatment The patient is put on surface traction for three weeks. Full weight bearing is permitted after 6 wks.

27. Elbow Dislocation Commonly 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 Dislocation Reduction Techniques..

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

31. Thank you for your attention.