DISLOCATION

GH

Humeral art surf ( Ball )

37 55 mm

41 mm
135

25 mm

Fossa Glenoid 75 % L
60 % T
Pear shaped , cartilage covered
bony depression
Lined by glenoid labrum
Post tilt + 7,4
Shoulder Muscles & Action
17 muscles involved in shoulder motion
Anterior Shoulder Dislocation
The most often happened
Mechanism :
- Falling on hands
- The humerus is pushed anteriorly
- Tearing the capsel
- Avultion of the Glenoid edge
Clinical sign :
- Incredible pain
- Patient supporting the injured side
- Lateral side of shoulder is flattenned
 X Ray :
AP Photo will show overlapping shadow
of humerus and fossa glenoid.
Lateral Photo will show the humerus
outside of the shoulder joint.

Therapy :
- Traction
- Kocher Method
- Imobilitation of the arm
- Moving of the other arm joint is
obligatory
 Early Complication :
- Nerve Injury
- Injured artery
- Dislocation with Fracture

Late Complication :
- Shoulder stiffness
- Uncorrected dislocation
- Repeated dislocation
Posterior Shoulder Dislocation
2 % of all shoulder dislocation
Mechanism :
A Strong indirect force that caused
internal rotation and adduction. Usually
happenned after epileptic attack or after an
electric shock
Clinical sign :
- Often undiagnosed
- Arm fixed at a medial rotation position
- Flattenned shoulder with protruding
korakoid (a superior view will help)
 X ray :
AP photo : abnormal looking of humerus
head ( like light bulb) and an empty glenoid
sign.
Lateral Photo : Show subluctation or
posterior dislocation
CT will helped in a difficult case
Therapy :
Reduction under total anesthesia, if stable
arm must be imobilized, if not keep the
shoulder in wide abduction and lateral rotaion
in gypsum
 Complication :
- Uncorrected dislocation
- Recurrent dislocation and
subluctation
Shoulder dislocation on kids
Traumatic dislocation is very rare
Usually due to daily activities wether it
happenned voluntary or involuntary
Examination will show that the shoulder is
sublucsated almost to every direction
Therapy :
First considered behavourial problems,
then a reconstructive surgery will helped
 HIP DISLOCATION
The increased number of traffic
accident hip dislocation is more
frequently happenned
Hip dislocation is classify into two
groups depending on the direction of
the dislocation :
- Posterior
- Anterior and center
Posterior Dislocation
Four out of five hip dislocation
When someone in a car is thrown out
anteriorly, causing the knee to hit the
dashboard.
Femur is pushed upward and the head
pops out of the joint and quite often a
part of the back of acetabulum is also
fractured
 Clinical sign :
- Adducted and shortened leg
- Internal rotation and a bit flexed
- If a femur fractured happenned checked for
a hip disloaction
X Ray:
Head of femur outside the joint cup and
over the acetabulum.The roof segment of
acetabulum and the head of femur might
fractured, an oblique view will show the size
of the fragment. CT Scan is still the best
diagnostic for fragmented femur/ acetabulum.
 Therapy :
- Reduction ASAP under general anesthesia
(Mostly closed reduction)
- Imobilization of the hip with traction
- Mobilization will started as soon as the pain
subsided
- Removal of intraarticular fragment (after the
patient stabilized)
- Type II; With open reduction and anatomic
fixation
- Type III; with closed reduction and an
opened surgery to remove the fragments
- Type IV & V; Closed reduction, surgery if the
fragments unreducted
 Early complication :
- Sciaticus nerve injury
- Injured Artery (Gluteal superior artery)
- Fracture of the femur body
Late complication :
- Avascular necrose
- Miositis ossificans
- Uncorrected dislocation
- Osteoarthritis
Anterior Dislocation
Rarely happenned
Clinical Sign :
- Outer rotation, abduction and a bit flexed
- A clear anterior protruded of the femur head
- No hip movement
X ray
AP photo usually a good diagnostic
procedure, if theres any doubt a lateral
photo will solved the problem
 Therapy:
Same manuver with posterior
dislocation except the thigh must be
adducted when it was pulled upward
Avascular Necrosis is the only
complication
Center Dislocation
Falling on the side or a force on the major
trochanter will pushed the head of femur to
the acetabulum floor and caused pelvic
fracture
Clinical sign : Normal position with bruises
and paun on the trochanter and hip, few
movement canbe executed
X ray : Head of femur is moved medially and
fracture of the acetabulum floor
 Therapy :
- Reduction and restoring the hip form
- Movement must be started as soon as
possible
Early Complication:
Shock and viceral injury
Late complication :
Stiffness of hip with or without
osteoarthritis
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