Dislocations

Question 1

what is the mechanism of shoulder dislocation?

Answer 1

Fall
Traction
Injury

Question 2

what is the most common shoulder dislocation?

Answer 2

Anterior

Caused by fall with shoulder in external rotation,

Axillary nerve can be damaged = regimental badge area sensory assessment

Question 3

Signsand causes of a posterior shoulder dislocation?

Answer 3

Cause: seizures

Light bulb sign,

Can also occur in fall with shoulder in internal rotation, humeral head displaces posterior to the glenoid

Question 4

what is an inferior shoulder dislocation?

Answer 4

RARE,

arm held in abduction,

humeral head displaced inferior to the glenoid,

needs prompt neurovascular assessment and reduction

Question 5

what is an associated injury with many shoulder dislocations?

Answer 5

labral tears etc.

Question 6

management of shoulder dislocation?

Answer 6

closed reduction
- open reduction
- stabilisation and rehabilitation

Question 7

what is the mechanism of elbow dislocation?

Answer 7

Tends to occur in children (holding parents hand - pulled elbow),

adults - sporting activities etc.)

Question 8

what damage can be caused by an elbow dislocation?

Answer 8

Small risk of radial head and coronoid process fractures

Elbow usually pretty stable due to ligaments and stabilisers

Ante cubital fossa: neurovascular structures

Question 9

how is an elbow dislocation managed?

Answer 9

closed reduction under sedation,
- 2 weeks in sling and rehabilitation
- Reduction methods: traction in extension +/- pressure over olecranon Recurrent instability risk is low!

Question 10

what is the mechanism of an interphalangeal joint dislocation?

Answer 10

Hyperextension injury, direct axial blow

• like a football hitting the finger

Question 11

how is an interphalangeal joint dislocation managed?

Answer 11

-Closed reduction under digital/metacarpal block (ring block) -

-2 weeks in neighbour strapping,

-volar slab in Edinburgh position if unstable

Question 12

what is the first thing to do with a patella fracture?

Answer 12

CONFIRM whether it’s a patella dislocation OR knee dislocation -

very different (has different mechanisms

Question 13

what is the mechanism of patella dislocation?

Answer 13

sudden quads contraction with a flexing knee

Question 14

who gets a patella dislocation?

Answer 14

-Teenagers (and more common in girls)

Associations/causes: -
-hyper-mobility,
- genu valgum,
- increased femoral neck anteversion),
- lateral quads insertions
- weak vastus medialis

Question 15

what else can be injured in a patella dislocation?

Answer 15

Can have torn MPFL (medial patella femoral ligament)

always lateral dislocation and often self-relocating

Question 16

how is patella dislocation managed?

Answer 16

reduce with knee extension,

radiographs,

aspiration,
brace,

physiotherapy

if repeat dislocations surgery: lateral release/medial reefing, patella tendon realignment

Question 17

what is the mechanism of knee dislocation?

Answer 17

High energy injuries,

Question 18

what are the possible injuries which can accompany knee dislocation?

Answer 18

Vascular injuries: popliteal artery/vein injury, may not be obvious (intimal tear/thrombus)

Nerve injuries: peroneal nerve

Question 19

how is a knee dislocation diagnosed?

Answer 19

plain radiographs,

there are associated fractures,

MRI

Question 20

What surgery is done for a knee dislocation?

Answer 20

Early - vascular repair (6hr window),
nerve repair

Definitive - sequential ligamentous repair

Complications: arthrofibrosis and stiffness, ligamentous laxity, nerve/arterial injury

Question 21

what is the mechanism of injury for a hip dislocation?

Answer 21

RTA dashboard injury,
-Fall from height etc

Question 22

how does a hip dislocation present?

Answer 22

flexed, internally rotated, and adducted knee

Question 23

what are the complications of hip dislocations?

Answer 23

sciatic nerve palsy, AVN of the femoral head, secondary OA of hip

Question 24

what way does the hip dislocate?

Answer 24

Dislocated posteriorly Associated with posterior acetabular wall and femoral fractures