dislocation

Question 1

what makes shoulder most dislocated

Answer 1

bcs of its wide ROM
shallow glenoid fossa
weak ligamemts
loose capsule

Question 2

most common type of shoulder disloc

Answer 2

anterior dislocation

Question 3

what mechanism results in anterior shoulder

Answer 3

forced abduction
forced extension
forced external rotation
or direct blow to posterior shoulder

Question 4

how would the arm with ant disloc be positioned

Answer 4

abducted and externaly rotated

Question 5

findings on physical exam of anterior dislocation

Answer 5

positive apprehension& relocation test

squared off shoulder

positive sulcus sign

chech axillary plus musculocutaneous nerve fx

Question 6

x ray findings in anterior dislocation

Answer 6

the humeral head is ant and inf to glenoid fossa

usually accompanied by bankart and hill-sachs lesion

Question 7

what is bankart lesion

Answer 7

involves the glenoid labrum tear in the labrum

Question 8

hill sach meaning

Answer 8

shown in xray in ant dislocation showing compression fracture of humeral head

Question 9

what mechanism result in post dislocation

Answer 9

Fall on an adducted, internally rotated, flexed arm or by FOOSH.

3 E’s: Ethanol, epilepsy, electrocution

Question 10

posterior dislocation arm whould present as

Answer 10

adducted
internally rotated

Question 11

What are the x-ray findings of posterior shoulder dislocation?

Answer 11

The humeral head can be normally aligned with the glenoid; however, presence of
other signs indicate a dislocated joint:
▪ Vacant glenoid sign: partial vacancy of the glenoid fossa.
▪ Positive rim sign: widened space between the anterior glenoid rim and the humeral head.
▪ Bulb sign: the humeral head looks like a lightbulb because it is internally rotated.

Question 12

what is colles fracture

Answer 12

It is a common fx of the distal radius as a result of a fall onto an outstretched hand (FOOSH) with the forearm pronated and wrist dorsiflexed (in at attempt to prevent the fall).

Question 13

What population is particularly susceptible to Colles fx?

Answer 13

Osteoporotic patients; particularly, elderly women.

Question 14

What appearance on examination is commonly associated with Colles fx?

Answer 14

Dinner fork deformity.

Question 15

what are the complications with colles

Answer 15

malunion and carpal tunnel syndrome (median nerve palsy)

Question 16

smith fracture

Answer 16

It is a fx of the distal radius as a result of a fall onto a flexed wrist or a blow to the back of the wrist causing palmar displacement or angulation

Question 17

what is smiths fracture also known as

Answer 17

reverse colles fracture

Question 18

what are the appearance on examination with smith fracture

Answer 18

garden spade deformity

Question 19

monteggia fracture

Answer 19

It is a fx of the proximal ulnar shaft with concomitant dislocation of the radial head (proximal radio-ulnar joint).

Question 20

what is the mneominic MUGR

Answer 20

Monteggia - Ulna
Galeazzi - Radius

Question 21

What are possible complications of Monteggia fx

Answer 21

▪ Compartment syndrome.
▪ Radial or posterior interosseous nerve injury.
▪ Valgus deformity of the elbow.

Question 22

galeazzi fracture

Answer 22

It is a fx of the distal radial shaft with concomitant dislocation of the distal radio-ulnar joint.

Question 23

types of fractures in montegia and galeazzi

Answer 23

montegia- oblique fx
galeazzi - transverse fx

Question 24

what is DDH

Answer 24

▶ It is a pediatric condition where the ball (femoral head) and socket (acetabulum) of the hip joint aren’t properly formed leading to an unstable hip and eventually, hip dysplasia.

Question 25

What are the risk factors for developing DDH? Risk factors - 5 Fs:

Answer 25

- Female baby - First born - Family history - Frank breech -Left hip -oligohydraminos( no enough space for the baby)

Question 26

wwhy is DDH common in kuwait

Answer 26

bcz of increased laxity of ligaments (predisposes to DDH), hypermobility , consanguinity and the tradition of newborn swaddling.

Question 27

how can DDH be diagnosed

Answer 27

it is a clinical diagnosis in newborns when they are born doing an exam to find out either barlow maneuver or ortolani maneuver

Question 28

what is barlow maneuver

Answer 28

hip and knee flexed the hip adducted posterior pressure on adducted hip to dislocate when u hear a clunk sound means dislocated

Question 29

ortolani maneuver

Answer 29

relocating the disloacted by anterior pressure on abducted hip with knees and hip flexed

Question 30

how would a child with ddh prsent

Answer 30

painless limp abnormal gait unequal limb positive trendelenburg delayed crawing or walking

Question 31

what are other findings on physical exam

Answer 31

- Limited abduction of flexed hip, deceased internal rotation and painless decreased range of motion. - Galeazzi sign: with hips and knees flexed, knees have unequal heights (leg length discrepancy) with the dislocated hip being on the side of the lower knee. - Asymmetric skin folds. - Atrophied thigh muscles and positive trendelenburg test in older ambulatory children.

Question 32

how to diagnose DDH

Answer 32

Hip ultrasound: best for evaluation of babies from six weeks to six months of age. ▶ Why not before six weeks? Not to over-diagnose DDH (false-positive one results). ▶ When to use it? ‘ In high-risk infants
























‘ If screening exam showed abnormal findings ‘ To monitor and follow up infants with DDH

Question 33

why not use xray to diagnose DDH

Answer 33

Because before 6 months, the hip joint consists of cartilage that hasn't yet undergone ossification and hence, cannot be visualized on x-ray.

Question 34

what is the most common cause of hip dislocation

Answer 34

High-energy trauma: young people involved in road traffic accidents; can follow hip replacement. ▶ Unlike the shoulder, the hip joint is inherently stable due to a deep labrum, tight capsule and strong ligaments.

Question 35

main type of hip dislocation

Answer 35

posterior

Question 36

What are the possible complications of hip dislocation (more with posterior)?

Answer 36

▪ Avascular necrosis (AVN) of the femoral head. ▪ Acetabular fx. ▪ Femoral head/neck fx. ▪ Sciatic nerve injury. ▪ Post-traumatic arthritis. ▪ Thromboembolism: DVT/PE.

Question 37

what is the mechanism of injury in post disloc of hip

Answer 37

flexed knee and hip and adducted hip with high force from infront cause post disloc (dashboard injury)

Question 38

how would the leg in post disloc be presented

Answer 38

affected hip flexed, adducted, internlly rotated

Question 39

How is posterior hip dislocation managed?

Answer 39

1) Initiate the Advanced Trauma Life Support (ATLS) protocol for trauma patients as 95% will have a n injury elsewhere (remember, a high-energy trauma is needed to dislocate a hip). 2) Perform a detailed neurovascular exam before reduction (sciatic nerve injury). 3) Examine the knee for injury/instability. 4) Initiate DVT prophylaxis (unless scheduled for surgery). 5) Urgently perform closed reduction of the hip under Iv sedation or general anesthesia within six hours. Why? To avoid AVN of femoral head.

Question 40

What mechanism results in anterior hip dislocation?

Answer 40

Force directed at the knee with the hip abducted and externally rotated.

Question 41

how to know if ant dislocation in xray

Answer 41

-The femoral head is anterior and inferior to the acetabulum. -The femoral head is externally rotated. -Disrupted shenton line.

Question 42

What mechanism of injury results in pelvic fxs?

Answer 42

High-energy trauma: road traffic accidents, pedestrian injury, fall from height. ✳ Can be lateral compression, AP compression or vertical shear. Can be low-energy trauma in the elderly. (The type of pelvic fx is determined by the type of injury and amount of energy.)

Question 43

What makes pelvic fxs an orthopedic emergency requiring immediate management?

Answer 43

Pelvic fxs have a mortality of 25% that can double in case of open pelvic fxs.

Question 44

what is th leading cause of mortality in pelvic fractures

Answer 44

Hemorrhage from veins and the highly vascular pelvic marrow, or less commonly from arteries. To loss

Question 45

What are the possible findings on physical examination? in pelvic fx

Answer 45

tachycardia, hypotension and altered level of consciousness. Patient can be in shock (blood loss can be up to 4 L with pelvic fx - a pelvic fx widens the true pelvis, accommodating more blood) Patient can still bleed from other injuries. Look for other serious injuries in the head, chest (tension pneumothorax, rib fx, cardiac tamponade), abdomen and spine.

Question 46

Young-Burgess Classification

Answer 46

fxs according to the type of force: Young- Burgess A implies lateral compression (as in pedestrian injuries), B implies AP compression (as on road traffic accidents) C implies vertical shear (as in fall from height

Question 47

AP compression forces result in what in xray

Answer 47

disruption/widening of the pubic symphysis (pubic diastasis) causing the pelvis to open like a book - open book fracture. It

Question 48

Lateral compression forces result in

Answer 48

Internal rotation of the hemipelvis where the force is directed causing sacral compression fx, while the other hemipelvis externally rotate causing diastasis o f t h e contralateral sacroilliac joint- w i n d - s w e p t fracture.

Question 49

ABC of burges

Answer 49

A Lateral compression--Pedestrianinjury windswepth B APcompression--RTA --open book C vertical shear--fall fromheight Buckethandlea

Question 50

What mechanism of injury results in femoral shaft (diaphysial) fxs?

Answer 50

High-energy trauma: young people involved in road traffic accidents. ▶ Low-energy trauma: in the elderly due to fall from standing or in abused children (spiral fx in the latter).

Question 51

What is so peculiar about femoral neck fxs?

Answer 51

The femoral neck is an intracapsular structure (covered by the joint capsule) and lacks a periosteal layer Limited callus formation and slowed healing.