CMR OF HIP DISLOCATION

Anatomy
• The hip joint has a ball-
andsocket configuration;
synovial articulation between
the head of the femur and the
acetabulum of the pelvis bone.
• The hip joint has a ball-
andsocket configuration;
synovial articulation between
the head of the femur and the
acetabulum of the pelvis bone.
• The joint is supplemented by
much stronger ligamentous
condensations iliofemoral
pubofemoral and ischiofemoral
ligaments that run in a spiral
fashion, preventing excessive hip
extension.
Classification
• Depending upon the position of the head with respect to the
acetabulum, hip dislocations are classified as:
• Posterior dislocations: Commonest and is seen in 80-90 percent of
the cases.
• Anterior dislocations: Seen in 10-15 percent.
• Central dislocations: Relatively rare
Posterior dislocation
• Also known as “dashboard injury
• They result from trauma to the flexed
knee, with the hip in varying degrees
of flexion. The femur is thrust
upwards and the femoral head is
forced out of its socket.
• The scenario is usually when someone
seated in a truck or car, during a road
accident is thrown forward striking
the knee against the dashboard.
• Seat-belt restraints can reduce the
number of posterior hip dislocation.
Clinical features
• There is usually history of
trauma
• The patient has a flexion,
adduction and medial rotation
deformity of the affected limb
• There is marked shortening and
gross restriction of all hip
movements.
• Head of the femur is felt as a
hard mass in the gluteal region
and it moves along with the
femur.
Anterior dislcoation
• Hyperextension force against an
abducted leg that levers head
out of acetabulum.
• Femoral head dislocated anterior
to acetabulum
• The hip is minimally flexed,
externally rotated and markedly
abducted
Anterior hip dislocation
Posterior hip dislocation
Methods of closed reduction
• Allis method
• Captain’s morgan technique
• Stimson’s gravity method
• Whistler’s technique(over-under)
 • The patient is placed supine the surgeon
standing above the patient on the
Allies method stretcher or table
• Initially, the surgeon applies inline
traction while the assistant applies
counter traction by stabilizing the
patient’s pelvis.
• While increasing the traction force, the
surgeon should slowly increase the
degree of flexion to approximately 70
degrees.
• Gentle rotational motions of hip as well
as slight adduction will often help the
femoral head to clear the lip of the
acetabulum.
• A lateral force to the proximal thigh may
assist in reduction. An audible “clunk” is a
sign of a successful closed reduction.
Captain’s Morgan technique
• Place patient on backboard,
attach a strap over the pelvis
• If your leg is much shorter than
the patient’s thigh,put a book
under your foot
• Lift your knee with a steady
sustained force, avoid sudden
jerky movements
• If it’s not moving, try internal
and external rotation at he hip
while lifting
 Stimson’s gravity method
• Reverse allis method of reduction
• Patient is prone
• Patient is brought to the edge of table
• An assistant stabilizes the pelvis by
applying downward pressure over the
sacrum
• The affected hip and knees are flexed
to 90 degrees.
• Downward pressure is applied on the
flexed knee.
• To facilitate the reduction, gentle
rotations needs to be done.
Whistler technique
• The patient lies supine on the gurney
• Unaffected leg is flexed with an
assistant stabalizing the leg.
• Provider’s other hand grasp the lower
leg of the affected leg,usually around
the ankle
• The dislocated hip should be flexed to
90 degrees
• The provider’s forearm is the fulcrum
and the affected lower leg is the lever
• When pulling down on the lower leg,
if flexes the knee thus pulling traction
along the femur
CMR OF SHOULDER
DISLOCATION
Epidemiology
• 1.7% population
• Bimodal distribution:
• Men in 20-30 yo (M:F 9:1)
• Women 61-80 (M:F 1:3)
• Less in children as their epiphyseal plate is weaker and tends to
fracture before dislocating.
• More common in elderly as the collagen fibres have fewer cross links
weaker capsule / tendons / ligaments.
Anatomy
• Involves
• Bones:
• Scapula, Humerus, Clavicle.
• Rotator Cuff Muscles: subscapularis,
supraspinatus, infraspinatus, teres minor.
• Assoc. muscles: deltoid, biceps, pectoralis.
• Capsules
• Ligaments:
• Stability of the glenohumeral joint is dependent on
four factors:
• The suction cup effect of the glenoid labrum
around the humeral head
• Negative gleno-humeral intra-articular pressure
and limited joint volume
• Static stabilisers, including labrum, ligaments and
joint capsule
• Dynamic stabilizers especially rotator cuff and
biceps muscle
• Subcoracoid (anterior):
Humeral head sits anterior and
medial to the glenoid, just
inferior to the coracoid. ~ 60%
of cases.
• Subglenoid (anteroinferior):
humeral head sits inferior and
slightly anterior to the glenoid,
that the humeral head has also
travelled medially. ~ 30% of
cases.
Milch technique
• The arm is abducted and
thephysician's thumb is used to
push the humeral head into its
proper position. Gentle traction
in line with the humerus is
provided with the physician's
opposite hand.
Kocher’s method
• Hand position: The clinician takes the
pateint’s elbow in the right hand and
the wrist in the left
• External rotation: Without applying
traction,the humerus is externally
rotated slowly and gently until
resistance is reached. The arm can
usually be rotated to 70-90 degree
• Lifting and adduction across
chest.Maintaining the external
rotation, the humerus is then lifted
forwards to teh front of the chest
• Internal rotation: Finally the shoulder
is rotataed internally to bring the hand
to the oppsite shoudler
Traction counter traction
• Note how the clinician on the
left has the sheetwrapped
around him, allowing him to use
hisbody weight to create
traction. Some clinicians employ
gentle external rotation to the
affected arm while providing
traction.