Common Dislocations Flashcards

1
Q

Where are common sites of dislocations?

A

Elbow, hip, shoulder, IP joints, patella, knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are common features of the history and examination in all dislocations?

A

Trauma = fall, RTA, sports injury, seizure
Inspection for deformity
Palpating = vascular supply, neurology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the common mechanics of shoulder dislocations, and what directions can the dislocations go in?

A

Fall, traction injury, common in young adults

Directions = anterior (most common), posterior, inferior (rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some features of an anterior shoulder dislocation?

A

Fall with shoulder in external rotation, humeral head anterior to glenoid, needs regimental badge area sensory assessment (axillary nerve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some features of posterior shoulder dislocations?

A

Fall with shoulder in internal rotation, direct blow to anterior shoulder, humeral head posterior to glenoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some features of inferior shoulder dislocations?

A

Arm held in abduction, humeral head inferior to glenoid, needs prompt neurovascular assessment and reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some management options for shoulder dislocations?

A

Closed reduction under sedation, open reduction, stabilisation and rehabilitation
Reduction methods = Hippocratic, in-line traction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a complication of shoulder dislocations?

A

Recurrent instability risk = related to age, risk of recurrence decreases with age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do elbow dislocations arise, and in what direction can it be dislocated?

A

Mechanism = fall onto outstretched hand
Directions = anterior, posterior, medial/lateral
Occurs in adults and children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some risks associated with elbow dislocations?

A

Small risk of radial head or coronoid process fracture

Low risk of recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How should elbow dislocations be managed?

A

Closed reduction under sedation, open reduction rarely required, 2 weeks in sling and rehabilitation
Reduction methods = traction in extension +/- pressure over olecranon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some features of interphalangeal (IP) dislocations?

A

Mechanism = hyperextension, direct axial blow

Always displaced posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some complications of IP dislocations?

A

Head of phalanx button holes through volar plate, recurrent instability due to associated fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should interphalangeal dislocations be managed?

A

Closed reduction under digital/metacarpal block, open reduction rarely required, 2 weeks in neighbouring strapping, volar slab in Edinburgh position if unstable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What reduction methods can be used to treat IP dislocations?

A

In-line traction plus corrective pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some features of patellar dislocations?

A

Mechanism = sudden quads contraction with a flexing knee
Always displaced laterally
Most common in teenagers, more common in girls

17
Q

What are some causes of patellar dislocations?

A

Hypermobility, under-developed (hypoplastic) lateral femoral condyle, increased Q angle, genu valgum, increased femoral neck anteversion, lateral quads insertion or weak vastus medialis

18
Q

How do patients present with a patellar dislocation?

A

Clear history of patella dislocating laterally, often self-relocating

19
Q

What would you expect to find on examination of a patient with patellar dislocation?

A

Pain medially = from torn medial retinaculum
Effusion = haemarthrosis
Positive patellar apprehension test

20
Q

How are patellar dislocations treated?

A

Reduce with knee expansion, radiographs, aspiration, brace, physio
Surgery for repeat dislocations = lateral release/medial reefing, patella tendon realignment

21
Q

How do knee dislocations occur and who gets them?

A

Mechanism = high or low velocity injuries

Most common in teenagers, more common in girls

22
Q

Why are knee dislocations missed, and why is it important that they are discovered?

A

May spontaneously relocate = lateral collateral ligament or peroneal nerve may be injured in initial dislocation

23
Q

What should you do in a patient with a normal examination but high clinical suspicion of a knee dislocation?

A

Observe in hospital and get arteriogram/MRI

24
Q

What structures may be damaged in a knee dislocation?

A

Peroneal nerve

Popliteal artery and vein = may not be obvious (intimal tear/thrombus)

25
Q

How should ligamentous stability be examined in a patient with a knee dislocation?

A

Under anaesthetic

26
Q

What is the urgent management for a knee dislocation?

A

Reduction under sedation, may require theatre reduction if condyle has button-holed through capsule, stabilise in splint or external-fixation

27
Q

What methods are used to image a dislocated knee?

A

Plain radiographs, MRI

28
Q

What surgery can be done for knee dislocations?

A

Early surgery = vascular repair (6hr window), nerve repair

Definitive surgery = sequential ligamentous repair

29
Q

What are some potential complications of a knee dislocation?

A

Arthrofibrosis and stiffness, ligament laxity, nerve or arterial injury

30
Q

What are some features of a hip dislocation?

A

Mechanism = RTA dashboard injury, fall from height
Most commonly posteriorly displaced
Associated fractures = posterior acetabulum wall, femoral

31
Q

How di hip dislocations present?

A

Flexed, internally rotated and adducted knee

32
Q

What is the early management of a hip dislocation?

A

Neurovascular assessment (especially sciatic nerve)
Radiographs (changes can be subtle)
Urgent reduction and stabilise in tractions if needed
Further imaging with CT

33
Q

What is the definitive management for a hip dislocation?

A

Fixation of associated pelvic fractures

Fixation of other injuries in poly-trauma patients

34
Q

What are some complications of hip dislocations?

A

Sciatic nerve palsy, avascular necrosis of femoral head, secondary osteoarthritis of hip