Lecture 4 - dislocation

Question 1

define dislocation

Answer 1

discontunity between the bone and the articular surface

Question 2

give the classification of dislocations

Answer 2

can be complete
can be partial

Question 3

explain the mechanism behind dislocations

Answer 3

can be dircte on the joint
can be indirect

Question 4

what is recurrent dislocation?

Answer 4

increasingly easier and more frequent reproduction of the dislocation

Question 5

where are recurrent dislocations most common ?

Answer 5

shoulder
temoromandibular
patellofemural

Question 6

what are the three aims of dislocation treatment

Answer 6

reduction
maintaining reduction
restoring function

Question 7

which group of people are more likely to experience acromioclavicular dislocation ?

Answer 7

young people falling on their shoulder

Question 8

explain the mechanism of acromioclavicular joint dislocation

Answer 8

extreme contraction of the trapezius and SCM

Question 9

classification of acromioclavicular dislocation

Answer 9

Complete - affecting both the acromioclavicular joint capsule and the coracoclavicular ligaments
Incomplete - affecting the acromioclavicular joint capsule with intact coracoclavicular ligaments

Question 10

clinical sign of ACJ dislocation

Answer 10

pain
stepladder sign, piano sign
loss of function

Question 11

treatment of complete dislocation of ACJ

Answer 11

reduction and immobilization with dessault for 6 weeks
or
rober jones and watson jones figure of 8 for 2-3 weeks

Question 12

treatment of old dislocation of ACJ

Answer 12

repaired with Dewar-Barrington technique, and also Weaver-Dunn technique (in type III) - uses the coracoacromial ligament (CA ligament) as a substitute to reconstruct the torn coracoclavicular (CC) ligaments.

Question 13

mechanism of indirct dislocation of the shoulder

Answer 13

Fall on the hand or elbow with arm in abduction and with external rotation

Question 14

rockwood classification

Answer 14

of the AC and CC ligaments

Question 15

types of anterior dislocation of the shoulder

Answer 15

○ extracoracoid,
○ subcoracoid (the most common),
○ intracoracoid,
subclavicular.

Question 15

classification of the shoulder dislocation

Answer 15

Depending on the location of the humeral head in relation to the glenoid cavity
Anterior - the most common, accounting for 95% of all.
Posterior
Inferior
Superior - although very rare

Question 16

clinical signs of anterior dislocation of the shoulder

Answer 16

humble position
internal rotation is possible
Berger sign
shoulder in epaulet

Question 17

what are the two types of posterior dislocation of the shoulder

Answer 17

Subacromial
Subspinous

Question 18

clinical sign of posterior dislocation of the shoulder

Answer 18

Location deformation is reduced

The arm is in internal rotation, and external rotation is impossible,

the humeral head can be palpated inferiorly by the postero-lateral angle of the acromion

Question 19

clinical picture inferior dislocation of the shoulder

Answer 19

In inferior dislocation, the humeral head is located subglenoid,

the humerus is in abduction

Rare 1 %

produced as a result of trauma with the arm in exaggerated abduction.

Question 20

diangosis of shoulder dislocation

Answer 20

Based on image and clinical evaluation

Neurological and vascular examinations are important to check for damage on vessels and nerves

Question 21

what are the main complication of shoulder dislocation

Answer 21

fractures (fracture of the greater tubercle, fracture-dislocation and parcelal fracture of the glenoid),

Question 22

treatment of shoulder dislocation

Answer 22

• Hippocratic technique
  
  • Kocker technique
  • Dessault bandage
  • Surgical procedures
    ○Bankart procedure for recurrent dislocations
    ○ Bristaw latarjet
    Transposition of the coracoid tip

Question 23

mechanism of elbow dislocation

Answer 23

Falling on the hand with forearm in extension and supination position

Through hyperextension, the anterior capsule and the medial and lateral collateral ligaments may tear and the coronoid may slide into the olecranon fossa,

with loss of the normal relationships of the radius and ulna to the humeral blade, through posterior or postero-external displacement.

Question 24

classification of elbow dislocation

Answer 24

can be posterior - most common anterior

Question 25

clinical sign of posterior dislocation

Answer 25

forearm is shorter

Question 26

clinical sign of posteroexternal dislocation of the elbow

Answer 26

the forearm is pronated with the humeral trochlea evident on the medial side of the elbow.

Question 27

clinical sign of posterio internal dislocation of the elbow

Answer 27

the forearm is pronated with the humeral trochlea evident on the medial side of the elbow.

Question 28

complications of elbow dislocation

Answer 28

* articular and periarticular calcifications, * post-traumatic arthrosis and * ischemic Volkmann syndrome

Question 29

anterior dislocation clinical sign

Answer 29

the elbow is in extension and the arm appears elongated when the dislocation is incomplete, or it is in flexion and the arm appears shortened when the dislocation is complete.

Question 30

explain the positon of posterior dislocation of the hip

Answer 30

high-iliac dislocations (the femoral head is elevated in the iliac fossa behind the acetabulum) low-ischial dislocations (the femoral head comes into contact with the sciatic spine)

Question 31

classifciation of hip dislocation

Answer 31

posterior most common anterior

Question 32

explain the postion of anterior dislocation of the hip

Answer 32

high-pubic dislocations (the femoral head is located in front of the pubis) low-obturator dislocations (the femoral head is located anterior to the obturator foramen)

Question 33

explain the clinical sign of posterior dislocations of the hip

Answer 33

adduction and internal rotation

Question 34

explain the clinical sign of anterior dislocations of the hip

Answer 34

abduction and external rotation,

Question 35

posterior high-iliac dislocation

Answer 35

the vicious position is in extension, adduction, and internal rotation.

Question 36

posterior low-sciatica dislocation

Answer 36

the vicious position is in flexion, adduction, and internal rotation.

Question 37

anterior high-pubic dislocatio

Answer 37

the vicious position is in extension, abduction, and external rotation.

Question 38

anterior low-obturator dislocation

Answer 38

the vicious position is in flexion, abduction, and external rotation.

Question 39

complications of hip dislocation

Answer 39

The category of immediate complications includes fractures-dislocations, neurological complications (compression of the sciatic, femoral or obturator nerve) and vascular complications (compression of the femoral vessels). Late complications include avascular necrosis of the femoral head, secondary post-traumatic arthrosis, and old unreduced dislocation.

Question 40

treatment of hip dislocation

Answer 40

ASAP to avoid late complications Performed under general and spinal anesthetics The thigh must be kept in 90 degrees Immobilization for 4-6 weeks Bohler technique