Dislocation

D: Displacement of the femoral head and the complete loss of articulation with the acetabulum. Dislocation can be posterior (90%) or anterior (10%).

A: Trauma.

A/R: There is usually an associated fracture of the acetabulum, femoral shaft, neck ^^ or head and sciatic nerve injury following posterior dislocations. Pre-existing disease of the femoral head, acetabulum or neuromuscular system are risk factors for hip dislocation.

_E Occurs commonly in the independent years of life with 70% of all hip dislocations being due to motor vehicle accidents.

H: History of severe trauma. The patient typically complains of severe pain in the hip and upper leg though there may also be knee, lower leg or back pain; is unable to weight bear or move the hip joint; and may have numbness or tir/ilir/i nf tho lone In noi rn\/acn 11ar inii tingling of the legs in neurovascular injury.

Posterior dislocation: Shortening, adduction and internal rotation of the affected limb. There may be a drop foot and sensory loss following sciatic nerve injury.

Anterior dislocation: The limb is flexed, abducted and externally rotated with the femoral head being palpable anteriorly.

Posterior dislocation: The femoral head is dislocated posterior to the acetabulum when the thigh is flexed. The femoral head is either displaced through a tear in the posterior hip capsule or the glenoid lip is avulsed from the acetabulum.

Anterior dislocation: The femoral head is dislocated anteriorly and usually remains lateral to the obturator externus muscle or lies under the iliopsoas muscle in contact with the superior pubic ramus.

Radiographs (AP, lateral and oblique): To evaluate the location of the femoral head relative to the acetabulum and to exclude any fractures.

Medical: Strong analgesia.

Surgery: If there are no fractures or there is only a small fracture, closed reduction is performed under general anaesthesia by stabilisation of the pelvis, traction in the line of deformity, flexion of the hip to 90°, then internal followed by external rotation. In irreducible or open dislocations, fractures of the acetabulum and redislocations after reduction, open reduction is performed.

Rehabilitation: The leg is held in traction for 1-2 weeks until the joint is pain-free. Simple movement and exercises are started within 1 week to maintain joint flexibility and the patient is started on crutches after 3 weeks.

Fractured acetabulum or femoral head, infection, avascular necrosis of the femoral head, post-traumatic secondary osteoarthritis, recurrent dislocation, sciatic nerve injury.

Good to excellent results in about 85% of patients.

^T^^B^D: Separation of the humeral head from articulation with the scapula. Commonest is anterior dislocation.

Falling onto an outstretched hand is the commonest route for anterior dis-

O locations. Posterior dislocations require an adducted arm and can be seen following seizures or electric shock.

H|a/R: Actions that involve abduction and rotation of shoulder joint have a higher risk of dislocation.

Common. Annual incidence is about 17/100000.

^IH History of fall, often onto outstretched hand.

Severe shoulder pain and restricted movement. There may be a history of previous dislocation.

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