Dislocation

Dr Win Min Thein

Associate Professor in Orthopaedics

Taylor’s University – School of Medicine

Taylor’s University – School of Medicine
Anterior dislocation
Most common

Mechanism of injury
Fall on the hand

Humerus driven forwards and tearing the capsule or

avulsing the glenoid labrum

Taylor’s University – School of Medicine

Clinical features:
Pain is severe

Patient supports the arm with the opposite

hand

Lateral outline of the shoulder may be

flattened

Bulge may be felt just below the clavicle

Dugas test and Hamilton’s ruler test

Taylor’s University – School of Medicine

Taylor’s University – School of Medicine
Taylor’s University – School of Medicine
 Treatment:
 Stimson’s technique
Patient left prone with the arm
hanging over the side of the bed
After 15 or 20 mins the shoulder
may reduce
 Hippocratic method
Gently increasing traction is applied
to the arm with the shoulder in
slight abduction, while an assistant
applies firm counter-traction to the
body
 Kocher’s method
The elbow bent to 90 degree and
held close to the body
No traction should be applied
Arm is slowly rotated 75 degree
laterally
The point of elbow is lifted forwards
and finally the arm is rotated
medially

Taylor’s University – School of Medicine

Taylor’s University – School of Medicine
Taylor’s University – School of Medicine
Complication:
 Early
Rotator cuff tear
Nerve injury (most commonly
axillary nerve)
Unable to contract the deltoid
and may be a small patch of
anaesthesia over the muscle.
Neuropraxia and recovers
spontaneously after a few weeks
Vascular injury (axillary artery)
Fracture dislocation
 Late
Shoulder stiffness
Unreduced dislocation
Recurrent dislocation

Taylor’s University – School of Medicine

Taylor’s University – School of Medicine
Taylor’s University – School of Medicine
 HIP DISLOCATION
The hip is an inherently stable joint and hip dislocation
requires high energy force

Associated injuries are common

These injuries are orthopedic emergencies, and the

dislocation of the hip should be reduced as quickly as
possible

The outcome is dependent on time to reduction, associated

injuries, post-reduction management, and type of injury

Taylor’s University – School of Medicine

Mechanism Of Iniury
A motor vehicle accident is the commonest
The position of the femoral head in relation to the acetabulum and
the vector of the force at the time of impact determine the type of
injury produced
Anterior dislocation is the result of abduction and extermal
rotation forces
These forces are applied with the hip flexed--- dislocates
inferiorly ( obturator)
With hip extension- ( pubic dislocation)

Taylor’s University – School of Medicine

Taylor’s University – School of Medicine
Posterior dislocation occur from a longitudinal force in line with the
femur acting on an adducted hip

Increased flexion and adduction at the time of injury favours pure

dislocation over fracture-dislocation

Taylor’s University – School of Medicine

 Associated injuries

Femoral head, neck, shaft fractures

Acetabulum and pelvic fractures

Sciatic nerve injury

Knee injuries including patellar #, ligament

ruptures and dislocation

Taylor’s University – School of Medicine

Taylor’s University – School of Medicine
Taylor’s University – School of Medicine
Treatment
Aim is to avoid complications
General guidelines are

(1) long-term results are directly related to the severity of the initial trauma,

(2) reduction, open or closed, should be performed within 12 hours, and

(3) only one or two attempts at closed reduction should be made; if these
fail, open reduction is indicated to prevent further damage to the femoral
head

Taylor’s University – School of Medicine

Gravity Method of Stimson

Taylor’s University – School of Medicine

Allis Maneuver

Taylor’s University – School of Medicine

Bigelow Maneuver

Taylor’s University – School of Medicine

Surgery

Absolute indications
(1) irreducible dislocation

(2) nonconcentric reductions with free intra-articular fragments of

bone or cartilage

(3) unstable fracture - dislocation

Taylor’s University – School of Medicine

THANK YOU

Taylor’s University – School of Medicine