♥ Complete loss of articulation between the two opposing surfaces of a joint.

♥ Incomplete dislocation = subluxation

Definition:

♥ Congenital : - Congenital Congenital : - Congenital dislocation of hipdislocation of hip

♥ Pathological : - polioPathological : - polio - infection - infection

♥ Traumatic : tear of Traumatic : tear of ligaments and capsuleligaments and capsule

Types:

Clinical picture♥ Severe painSevere pain♥ Loss of movementsLoss of movements♥ Abnormal position of the limbAbnormal position of the limb♥ Altered bony landmarksAltered bony landmarks

Treatment

♥ Urgent reduction : Urgent reduction : Under General Under General AnesthesiaAnesthesia

♥ SplintageSplintage ( fixation )( fixation )

Complications♥ Nerve injuries:Nerve injuries: - shoulder- shoulder : : axillary N.axillary N.

- hip- hip : sciatic N. : sciatic N.

♥ Vascular injuries:Vascular injuries:

♥ Recurrent dislocations : ( Recurrent dislocations : ( shouldershoulder ++) ++)♥ Avascular Necrosis and OsteoarthritisAvascular Necrosis and Osteoarthritis♥ Joint stiffness :Joint stiffness : - - adhesionsadhesions -- myositis ossificans myositis ossificans

Dislocations of specific joints

♥ ShoulderShoulder♥ ElbowElbow♥ HipHip

♥ Knee injuriesKnee injuries

Shoulder DislocationIt is the most commonly It is the most commonly

affected joint due to :affected joint due to :♥ Wide range of movementsWide range of movements♥ Shallow glenoidShallow glenoid♥ Weak capsuleWeak capsule♥ 45% of dislocations.** Usually anterior dislocation Usually anterior dislocation

Clinical picture♥ Severe pain and loss of Severe pain and loss of

movementsmovements♥ Arm abductedArm abducted♥ Loss of rounded contour of Loss of rounded contour of

the shoulderthe shoulder♥ Prominent acromionProminent acromion♥ Humeral head locatedHumeral head located sub- coracoid .sub- coracoid .

normal shoulder dislocated shouldernormal shoulder dislocated shoulder

Treatment

♥ Urgent reductionUrgent reduction U.G.A.U.G.A.

♥ Strapping : Strapping : to allow healing of the to allow healing of the

torn labrum and capsule.torn labrum and capsule.

Complications♥ Neuro -vascular injuries: Neuro -vascular injuries:

axillary N.axillary N.

♥ Recurrent Dislocation : Recurrent Dislocation : if not treated adequately at if not treated adequately at first.first.

Recurrent anterior dislocation of the shoulderRecurrent anterior dislocation of the shoulder Inadequate ttt. of the first Inadequate ttt. of the first

dislocation usually leads to :dislocation usually leads to :

♥ Persistent avulsion of the Persistent avulsion of the labrum (labrum (Bankart lesion )

♥ Redundant capsule andRedundant capsule and gleno-humeral lig.gleno-humeral lig.

♥ A posterolateral head defect is caused by an impression fracture on the glenoid rim (Hill-Sachs lesion )

CLINICALLYCLINICALLY: :

**♥ Easy, repeated Easy, repeated

dislocation.dislocation.♥ Patient can Patient can

reduce it easily.reduce it easily.

• Hill-Sachs lesion

Treatment of recurrent dislocation Treatment of recurrent dislocation shouldershoulder: :

♥ Fixation of the Fixation of the avulsed glenoid avulsed glenoid labrum.labrum.

♥ Tightening of the lax Tightening of the lax capsule.capsule.

Surgically , or better Surgically , or better arthroscopicallyarthroscopically ..

Dislocation of the Elbow

♥ Usually posterior : Usually posterior : with or without fr. with or without fr. coronoid.coronoid.

♥ Rarely anterior : Rarely anterior : with fr. olecranon.with fr. olecranon.

♥ Sometimes lateral or Sometimes lateral or medialmedial

Clinically: ♥ Pain, loss of Pain, loss of

movementsmovements

♥ Altered bony Altered bony landmarks.landmarks.

Treatment: ♥ Reduction under general Reduction under general

anesthesiaanesthesia♥ Splintage : by post. plaster slabSplintage : by post. plaster slab

COMPLICATIONSCOMPLICATIONS : :♥ Myositis ossificansMyositis ossificans

Treatment of neglected dislocation

♥ ArthrodesisArthrodesis♥ Arthroplasty : Arthroplasty : - interposition arthroplasty - interposition arthroplasty

- replacement arthroplasty- replacement arthroplasty

Dislocation of the Hip♥ Usually Usually posteriorposterior : : due to severe trauma due to severe trauma to flexed hip & knee [dash-to flexed hip & knee [dash-

board accidents].board accidents].♥ AnteriorAnterior dislocation : dislocation :

very rare.very rare.♥ CentralCentral dislocation : dislocation :

associated with fr. associated with fr. acetabulum.acetabulum.

Anterior Dislocation of the Hip

Central dislocation

[ Fracture acetabulum]

Clinical picture ♥ Severe pain & loss of Severe pain & loss of

movements.movements.♥ Flexion, adduction, and Flexion, adduction, and

internal rotation internal rotation of the affected limb.of the affected limb.♥ Femoral head felt in the Femoral head felt in the

gluteal region.gluteal region.♥ Absent femoral pulse.Absent femoral pulse.

Complications ♥ Early :Early : Sciatic nerve injury.Sciatic nerve injury.♥ Late : Late : AVN of the femoral head, AVN of the femoral head,

leading to O.A. of the hip .leading to O.A. of the hip .

Treatment♥ Recent :Recent : - urgent reduction U.G.A.- urgent reduction U.G.A. - splintage [ skin traction ].- splintage [ skin traction ].

♥ Neglected cases with AVN and O.A. :Neglected cases with AVN and O.A. : - arthrodesis [ in young patients].- arthrodesis [ in young patients]. - Total Hip Replacement- Total Hip Replacement ( T.H.R.)( T.H.R.) [ in older age ] .[ in older age ] .

Knee InjuriesKnee Injuries♥ Common in contact sports, football, and Common in contact sports, football, and

accidents.accidents.♥ Many structures inside, give the same Many structures inside, give the same

symptoms : symptoms : -- pain & tenderness. pain & tenderness. -- swelling [ effusion ] . swelling [ effusion ] . -- instability . instability . -- limitation of movements. limitation of movements.

Internal Derangement of the Knee ( I.D.K. )Lesions causing pain or instability of the knee.Lesions causing pain or instability of the knee.

♥ Meniscal injuries : Meniscal injuries : -- medial medial -- lateral lateral♥ Cruciate ligaments :Cruciate ligaments : - - anterior [ A.C.L.] anterior [ A.C.L.] -- posterior [ P.C.L.] posterior [ P.C.L.]♥ Collateral ligaments : Collateral ligaments : - - medialmedial - - laterallateral

Diagnosis of Knee Injuries ♥ History : traumaHistory : trauma♥ Clinical examination :Clinical examination : -- inspection inspection -- palpation palpation -- special clinical tests special clinical tests

♥ Special investigations :Special investigations : -- x-ray x-ray -- M.R.I. M.R.I. -- aspiration of effusion aspiration of effusion and haemarthrosis and haemarthrosis

Special clinical tests for diagnosis of knee injuries

♥ Meniscal lesions :Meniscal lesions : -- Mc Murray’s test . Mc Murray’s test .♥ Cruciate ligaments :Cruciate ligaments : -- anterior & posterior anterior & posterior drawer testsdrawer tests♥ Collateral ligaments :Collateral ligaments : -- varus & valgus varus & valgus stress tests .stress tests .

Treatment of knee injuries♥ Mild cases Mild cases ( sprains)( sprains) : : -- conservative ttt. : bandage or conservative ttt. : bandage or plaster cast + plaster cast + med. ttt.med. ttt.

♥ Severe cases Severe cases ( tears )( tears ) : : -- surgical ttt. : surgical ttt. : ** menisci : - repair menisci : - repair - excision- excision ** ligaments : ligaments : - early repair - early repair

- late reconstruction.- late reconstruction.

Surgical interference is mostly Surgical interference is mostly arthroscopicarthroscopic

♥ Arthroscopy can be Arthroscopy can be used for both used for both diagnostic and diagnostic and therapeutic therapeutic purposes.purposes.