Pembimbing:

dr. Nur Kholis Majid, Sp. OT

Disusun oleh:

Iqnasia Windy Novitasari

I11111059
KEPANITERAAN KLINIK ILMU BEDAH
RSUD DR ABDUL AZIZ SINGKAWANG
FAKULTAS KEDOKTERAN UNIVERSITAS TANJUNGPURA
PONTIANAK
2016

DISLOCATION

DEFINITION
It is complete and persistent displacement of a
joint in which at least part of the supporting joint
capsule and some of its ligaments are disrupted.

TYPES OF
DISLOCATION

Congenital

Acquired
1. Traumatic
2. Pathological e.g. TB hip, Septic Arthritis
3. Paralytic e.g. Poliomyelitis, cerebral palsy,
etc
4. Inflammatory disorders, rheumatoid
arthritis, etc

DISLOCATION
Most commonly occur in the following joints:
Shoulder
Hip
Elbow
Metacarpophalengeal joint
Facet joint dislocation in cervical spine.
Acromiclavicular joint dislocation.

PRINCIPLE OF
MANAGEMENT
Acute dislocation should be reduced as soon as
possible.
Open reduction is rarely necessary for acute
dislocation.
Close reduction with intravenous analgesia and
sedation or under GA should be attempted first
for most uncomplicated dislocation.
RICE : Rest, Immobilize, Cold, Elevate

PRINCIPLE OF
MANAGEMENT
It is an orthopedic emergency.
Reduction should be quick and prompt.
Reduction should always be under G/A or
sedation.
Swelling is less in compared to fractures.
Movements are more restricted than in
fractures.

PRINCIPLE OF
MANAGEMENT
Closed reduction is sufficient in most of the
times.
Open reduction is restored to if specifically
indicated.
Reduction techniques should always be very
gentle.
Pain will not subside by splinting unlike
fractures.

SHOULDER
DISLOCATION
Types:
Anterior dislocation:
Subcoracoid
Subglenoid
Sub-infraclavicular
Inferior
Posterior Dislocation

GLENOHUMERAL
DISLOCATION

ANTERIOR
DISLOCATION

REDUCTION
TECHNIQUES

Stimsons Gravity Method

REDUCTION
TECHNIQUES

KOCHERs Method

AFTER TREATMENT
The arm should be fasten to the chest with a body
bandage minimum period of three weeks.

ELBOW DISLOCATION

ELBOW DISLOCATION
Commonly due to fall on outstretched hand.
Closed reduction and long arm back slab for 3 weeks
is the treatment of choice.

HIP DISLOCATION
Thompson and Epstein classified posterior
dislocations of the hip into 5 types:
Type I

: Dislocation with or without minor

fracture

Type II

: Dislocation with a large single fracture

of the posterior acetabular rim

Type III : Dislocation with comminution of the

posterior acetabular rim with or without a
major fragment
Type IV : Dislocation with fracture of the
acetabular floor

TYPE 1

A, Type I posterior dislocation of hip. B, Osteonecrosis of femoral head

8 months after closed reduction. Note sclerosis of head, narrow joint
space, and irregularity of joint surfaces.

Widening of medial joint space after closed reduction of

type I posterior dislocation of hip suggests retained
osteocartilaginous fragments within joint.

TREATMENT
A type I dislocation is treated by closed reduction,
if possible, followed by immobilization in Buck
traction, an abduction pillow, knee immobilizer
(preventing hip flexion), or Thomas splint.

CLOSED REDUCTION
The following reduction maneuvers have been
described for posterior dislocations of the hip. The
gravity method of Stimson generally is believed to
be the least traumatic, but it is impractical in
patients with other injuries because it requires the
patient to lie prone.

GRAVITY METHOD OF
STIMSON
The patient is laid prone
on a table or cart with
both lower extremities
hanging off the end. An
assistant stabilizes the
pelvis, while the involved
hip and knee are flexed
90 degrees. The surgeon
grasps the leg just distal
to the flexed knee and
applies a longitudinal
force. Gentle internal and
external rotation of the
hip may aid the
reduction.

ALLIS MANEUVER
With the patient
supine, the pelvis is
stabilized by an
assistant applying
pressure to the anterior
superior iliac spines.
The surgeon applies
longitudinal traction in
the direct line of the
deformity followed by
flexion of the hip to 90
degrees while
continuing traction.
Internal and external
Allis reduction maneuver for posterior
rotations of the hip are

BIGELOW MANEUVER
With the patient supine, the
pelvis is stabilized by an
assistant applying pressure to
the anterior superior iliac
spines. The surgeon grasps the
affected limb by the ankle and
places his or her opposite
forearm beneath the patient's
flexed knee. Longitudinal
traction is applied in the
direction of the patient's
deformity, followed by flexion of
the patient's hip to 90 degrees
or more, while maintaining it in
an adducted, internally rotated Bigelow reduction maneuver
position and continuing
for posterior dislocation of

EAST BALTIMORE
With the patient supine, the surgeon stands on
the affected side with an assistant on the opposite
side. The patient's leg is flexed so that the hip and
knee are at 90 degrees. The surgeon places his or
her arm that is closest to the patient's head under
the proximal calf of the patient, cradling the leg in
his or her elbow with his or her hand resting on
the shoulder of the assistant. The surgeon's other
hand grips the patient's ankle. The assistant's arm
passes under the proximal calf of the patient
(similar to the surgeon's) and rests on the
surgeon's shoulder. The surgeon and assistant
squat slightly with knees bent. They straighten up
together to apply traction to the hip without
straining their backs. The surgeon rotates the leg

EAST BALTIMORE

OPEN REDUCTION
Anterior and posterior approaches have been
described for reduction of posterior dislocations of
the hip. Some authors have noted more frequent
osteonecrosis after the use of an anterior
approach, probably because the posterior
retinacular vessels are injured during the
dislocation, and the anterior approach injures the
remaining anterior vascular supply. Most of the
offending structures in an irreducible posterior
dislocation are reached more easily through a
posterior approach.

AFTER TREATMENT
The patient is put on surface traction for three
weeks.
Full weight bearing is permitted after 6 weeks.

KNEE JOINT
DISLOCATION

MP JOINT
DISLOCATION

IP DISLOCATION
Reduction Techniques..

THANK YOU