DISLOCATION

SPRAIN VS DISLOCATION

Sprain / Damaged the Ligaments  —> RICE Method 

• Cause: Stretching or tearing the ligament due to a sudden twist, fall, or impact.
• Common sites: Ankles, Wrists, and Knees.
• Symptoms: 

Pain around the joint

Swelling 

Bruising 

Limited movement

• Joint Position: The bones remain in place, but the ligament is injured. 

Dislocation / Damaged Joint or Bone alignement  —> Reduction + Immobilization + Rehab

• Cause: Trauma (Fall, accident, or sport injury) 
• Common sites: Shoulder, Fingers, Elbow, Hip, and Knee. 
• Symptoms: 

Deformity or out of place joint

Sever pain 

Inability to move the joint

• Joint Position: The bones are no longer aligned, often visibly so. 

Why dislocation is an emergency?

• Continues pain which is due to stretching of the capsule containing nerve endings
• Articular cartilage damage (gets nutrition for synovial fluid), due to risk ischemia if dislocation not reduced within 6 hours.
• First 24 hours carries the risk that it will be impossible to achieve a stable close reduction.

Goals of reduction:

• To prevent neuro-vascular compromission 
• To restore position (alignment, rotation, and length) joint
• To decrease pain 
• To prevent later deformity 
• To encourage healing and normal use of the bone and limb.

After care: 

• Neurovascular re-assessment 
• Stability of the joint 
• Check X-ray
• Immobilized in IR

TECHNIQUE OF REDUCTION MANEUVERS:

I. SHOULDER DISLOCATION [Anterior (95%) / Posterior (5%)], often due to falls or sports injuries. 

KOCHER: TEAI

• T: Traction with positioning the patient’s elbow is bent to 90 degrees and the arm is brought against the side of the body.
• E: External Rotation / Slowly rotate the forearm outward until resistance is felt. This externally rotates the humeral head, presenting a larger articular surface to facilitate reduction.
• A: Adduction /  Lifte and adducted the arm across the chest wall to midline. 
• I: Internal Rotation / Slowly rotate the arm inward to complete the reduction.

Note:

• Patient above 30 years old immobilized for 3 weeks 
• Patient under 30 years old less re-dislocation rate so immobilized for 1 week to decrease joint stiffness. 
• Gentle pendular ROM exercises decrease risk of frozen shoulder. 

HIPPOCRATIC 

STIMSON

MILCH'S 

II. Elbows: Common in children, often due to falls. 

III. HIP DISLOCATION [Anterior / Posterior (85% - 90%)], particularly in older adults. 

ALLIS' METHOD

• The patients is supine on the floor under GA / Sedation
• The hip is flexed to 90 degree
• Assistant stabilizing the pelvis
• Longitudinal traction is a given 
• The limb is abducted, externally rotated and extended. 

Management after reduction:

• Limb is support, with light traction for 3 weeks
• Partial weight bearing - 3 weeks with crutches 
• Full weight bearing - after 6 weeks 
• Mobilizing exercise for the hip and knee are begun after a few days and gradually intensified.

Knees: often resulting from accidents or sports. 

Fingers: