Common Dislocations

Question 1

What is important in the history taking of dislocations?

Answer 1

TRAUMA: falls, RTA, sports injuries, seizures

Question 2

What type of examination should be done in dislocations?

Answer 2

Inspection: deformity
Palpation: vascular supply, neurology - must be examined and documented before intervention

Question 3

What is the common mechanism of injury that leads to a shoulder dislocation?

Answer 3

Fall with the shoulder in external rotation - anterior
Fall with the shoulder in internal rotation or direct blow to the shoulder - posterior
Arm held in abduction - inferior

Question 4

How can a shoulder dislocate?

Answer 4

Anteiror - common
Posterior
Inferior - RARE

Question 5

Who is likely to get a shoulder dislocation?

Answer 5

Common in young adults

Question 6

What neurological assessment needs to be done in anterior dislocations?

Answer 6

Regimental badge area sensory assessment - axillary nerve

Question 7

What neurological disorder are posterior dislocations associated with?

Answer 7

Seizure

Question 8

What is the cardinal sign of a posterior dislocation on x-ray?

Answer 8

Light bulb sign

Question 9

How is a shoulder dislocations managed?

Answer 9

Closed reduction under stabilisation
Open reduction
Stabilistaion and rehabilitation

Question 10

What is the type of reduction method used in closed shoulder reductions?

Answer 10

Hippocratic, in-line traction

Question 11

What directions can an elbow dislocate?

Answer 11

Posterior
Anterior
Divergent
Medial/ lateral

Question 12

What are the associated fracture risks with elbow dislocations?

Answer 12

Radial head or coronoid process

Question 13

What structures are at risk with an elbow dislocation?

Answer 13

Anteriorly: brachial artery and median nerve
Posteriorly: radial nerve

Question 14

How can neurovascular status be assessed in children?

Answer 14

Make an OK sign: median nerve
Point - motor of radial
Starfish - ulnar

Question 15

How can an elbow dislocation be managed?

Answer 15

Closed reduction under sedation
Open reduction is rarely needed
2 weeks in a sling and rehab

Question 16

What are the different reduction methods utilised in elbow dislocations?

Answer 16

Traction in extension +/- pressure over the olecranon

Question 17

What is the mechanism of injury of an IPJ?

Answer 17

Hyperextension with a direct axial blow

Question 18

What way with an IPJ dislocate?

Answer 18

Almost always posterior

Question 19

What complications can occur with IPJ dislocations?

Answer 19

Head of phalanx button-holes through volar plate

Recurrent instability due to associated fracture

Question 20

What is the management for an IPJ dislocation?

Answer 20

Closed recution under digital or metacarpal block
2 weeks in neighbour strapping
Volar slab in edinburgh position if unstable

Question 21

What reduction methods are used for IPJ dislocations?

Answer 21

In line traction with corrective pressure

Question 22

What is the mechanism for patellar dislocation?

Answer 22

Sudden quads contraction with a flexing knee

Question 23

How will the patella dislocate?

Answer 23

Always laterallly

Question 24

Who is likely to get a patellar dislocation?

Answer 24

Most common in teenage girls

Question 25

What can cause patellar dislocations?

Answer 25

Hypermobility Under-developed lateral femoral condyle Increased Q angle (genu valgum, increased femoral neck anteversion) Lateral quads insertions or weak vastus medialis

Question 26

What is the Q angle?

Answer 26

Line from ASIS to midpoint of patella | Second line from tibial tubercle to midpoint of patella

Question 27

How will a patellar dislocation present?

Answer 27

Clear history of patella dislocating laterally | Self-relocating

Question 28

What will a patellar dislocation show upon examination?

Answer 28

Pain medially from a torn medial retinaculum Haemarthrosis Patellla apprehension test

Question 29

How are patellar dislocations managed?

Answer 29

``` Reduce with knee extension Radiographs Aspiration Brace PT ```

Question 30

What surgery can be performed for recurrent dislocations?

Answer 30

Lateral release Patella tendon realignment Reconstruction of MPFL with a graft

Question 31

Why should a spontaneous knee relocation not be missed?

Answer 31

LCL injury | Fibular nerve injury

Question 32

What type of knee dislocation can injure the popliteal artery?

Answer 32

Posterior dislocation

Question 33

What shouldy you do if you suspect a vascular injury in a knee dislocation?

Answer 33

Arteriogram/ MRI

Question 34

How is a knee dislocation managed?

Answer 34

Reduction under sedation | May require theatre reduction if condyle button holed through the capsule

Question 35

What are the complications of a knee dislocations?

Answer 35

Arthrofibrosis and stiffness Ligament laxity Nerve or arterial injury

Question 36

What are the common mechanisms of hip dislocations?

Answer 36

High velocity: RTA dashboard injury, fall from height

Question 37

What direction will hips commonly dislocate?

Answer 37

Posteriorly

Question 38

What are the associated fractures that can occur with a hip dislocation?

Answer 38

Posterior acetabular wall | Femoral

Question 39

How will a dislocated knee present?

Answer 39

Flexed, internally rotated and adducted

Question 40

How is a dislocated hip managed?

Answer 40

``` Neurovascular assessment (esp. sciatic nerve) Radiographs Urgent reduction Stabilise in tractions if required CT ```

Question 41

What are the complications of hip dislocations?

Answer 41

Sciatic nerve palsy AVN of the femoral head Secondary OA