Dislocation

Definisi

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persendian terhadap tulang lain
 Tipe Dislokasi
 Congenital
 Acquired
1. Traumatic
2. Pathological e.g. TB hip, Septic Arthritis
3. Paralytic e.g. Poliomyelitis, cerebral palsy, etc
4. Inflammatory disorders, rheumatoid
arthritis,etc
 Dislokasi
 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.

 Investigations
 Radiograph of the affected part should include
anterior posterior and lateral views and
sometimes special views needed.
 CT Scan
 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.
 Complication
1. Acute: Injury to peripheral nerve and vessels
2. Chronic: Unreduced dislocation
Recurrent dislocation
Traumatic osteoarthritis
Joint stiffness
Avascular necrosis
Myositis ossificans
 Caution !
 Excessive force should not be used in close
reduction.
 Forceful manipulation may lead to fracture.

 Interposition of soft tissue, bony fragment may

make close reduction impossible.
 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.
 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.
 Shoulder Dislocation
 Types:
 Anterior dislocation: Varities of dislocations like
Subcoracoid, subglenoid, sub-infraclavicular,
inferior.
 Posterior Dislocation
Radiological Images
Anterior Dislocation
Radiological Images
Anterior dislocation

 Occurs with the arm

held in abduction and
external rotation.
 Radiological Images
Posterior Dislocation

 Causes
1. Epilepsy
2. Electrocution
Reduction Techniques

 Stimson’s Gravity Method

Reduction Techniques

KOCHER’s Method
Reduction Techniques
 After Treatment
 The arm should be fasten to the chest with a
body bandage minimum period of three weeks.
Hip Dislocation

Types:
A. Posterior Dislocation

B. Anterior Dislocation

C. Center Dislocation
Mechanism of Dislocation
Hip Dislocation
 Clinical Features:
o The patient has a flexion,
adduction and medial
rotational deformity of
the affected limb.
o Hip movement grossly
restricted.
Radiological Images
Hip dislocation
 Hip Dislocation
Reduction 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.
 Hip Dislocation
After Treatment
 The patient is put on surface traction for three
weeks.
 Full weight bearing is permitted after 6 wks.
 Elbow Dislocation
 Commonly due to fall on
outstretched hand.
 Closed reduction and long
arm back slab for 3 wks is
the treatment of choice.
MP Joint Dislocation
IP Dislocation

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