2. MUHAMMAD FARRUKH BASHIR
DISLOCATIONS
AND
TREATMENT
MUHAMMAD FARRUKH BASHIR
FCPS (ORTHO)

3. JOINTS
AC JOINT
SHOULDER
ELBOW
KNEE
HIP
ANKLE

4. SHOULDER
ANATOMY

5. Pathoanatomy HILL SACHS LESION BANKART LESION
POSTEROLATERAL HEAD DEFECT
BANKART LESION
AVULSION OF ANTEROINFERIOR LABRUM

6. CLINICAL EVALUATION
Prominent acromion, sulcus sign, palpable humeral head anteriorly
Intense pain.

7. Types Anterior ..most common. Posterior..(epileptic .electric shock)
Superior
Subcoracoid

8. Investigation AP Axillary Special Views:
West Point axillary: for visualization of glenoid rim
Hill-Sach view: internal rotation view
Stryker Notch: view 90% of posterolateral humeral head

9. Reduction Under proper analgesia Most Common Techniques
Kocher (71-100%)
External Rotation (78-90%)
Milch (70-89%)
Stimson (91-96%)
Traction/Countertraction
Scapular Manipulation (79-96%)
Under proper analgesia

10. contd Kocher Arm is adducted and flexed at the elbow
Externally rotate arm until resistance is felt
The ER arm is flexed forward as far as possible
The arm is internally rotated

11. Post reduction
Only 2-3 weeks immoblization

12. HIP DISLOCTION

13. TYPES OF IP DISLOCATIONS
POSTERIOR.MOST COMMON
ANTERIOR.
SUPERIOR
INFERIOR

14. Clinical
Post :internally rotated shortened limb

15. Thompson and Epstein Classification of Hip Dislocations
Type I Pure dislocation with at most a small wall fragment.
Type II Dislocation with large posterior wall fragment.
Type III Dislocation with comminuted posterior wall.
Type IV Dislocation with “acetabular floor” fracture (probably transverse + post. wall acetabulum fracture-dislocation).
Type V Dislocation with femoral head fracture.

16. Investigation
X rays; AP
LATERAL
CT SCAN

17. REDUCTION
ALLIS
EAST BALTIMORE
STIMSON
Open reduction

18. Post reduction
Immoblize for 2-3 weeks.

19. Elbow dislocation

20. Terrible triad
Elbow dislocation+radial head Fx+coronoid Fx+lateral colleteral ligament tear

21. Types

22. X ays AP
LATERAL
Ct scan

23. Reducton
Close
Open
If unstale:

24. Post reduction Immoblize 2-3 weeks Start ROM as early as possible….
Elbow notorious for adhesion.