CSS Dislocation

DISLOCATION OF HIP

• POSTERIOR DISLOCATION• ANTERIOR DISLOCATION• CENTRAL DISLOCATION

POSTERIOR DISLOCATION

• Usually in a car accident in a truck or car is thrown forward – strikingknee against dashboard

• Mostly in a driver worker, taxy driver etc

POSTERIOR DISLOCATION

• Clinical Features:• the leg is short and lies adducted,

• internally rotated and

• slightly flexed.

The golden rule is to x-ray the pelvis in every case of severe injury

and, with femoral fractures, to insist on an x-ray that includes both

the hip and knee.

POSTERIOR DISLOCATION

• Xray Photos

POSTERIOR DISLOCATION

• Xray Photos

Treatment

• The dislocation must be reduced as soon as possible under

general anaesthesia.

• In the vast majority of cases this is performed closed, but if this

is not achieved after two or three attempts an open reduction is

required.

Treatment

• by applying traction in the line of the femur as it lies (usually in

adduction and internal rotation),

• and then gradually flexes the patient’s hip and knee to 90 degrees,

maintaining traction throughout.

• At 90 degrees of hip flexion, traction is steadily increased and

sometimes a little rotation (either internal or external) is required to

accomplish reduction

• Another assistant can help by applying direct medial and anterior

pressure to the femoral head through the buttock

Complication

• EARLYSciatic nerve injuryVascular injuryAssociated fractured femoral shaft• LATEAvascular necrosis= 10% of trauma hip. If

reduction delay than 12 hours the figure rises to 40%. Myositis ossificansUnreduced dislocationOsteoartrhitis.

Prognosis

• if the reduction was per- formed promptly (within 6 hours), then

no more than 6 weeks should suffice,

• but if there was a longer delay then an extended period of 12

weeks may be wiser.

Anterior dislocation

• nowadays the usual cause is a road accident or air crash

Clinical Features

• The leg lies externally rotated, abducted and slightly flexed.

• Seen from the side, the anterior bulge of the dislocated head is

unmistakable, especially when the head has moved anteriorly

and superiorly.

Anterior dislocation

Central Dislocation

• A fall on the side, or a blow over the greater trochanter, may

force the femoral head medially

• through the floor of the acetabulum. Although this is called

‘central dislocation’, it is really a fracture of the acetabulum

Dislocation of knee

• Clinical Features1. Rupture of the joint capsule produces a leak of the

haemarthrosis, leading to severe bruising and swelling.

2. the diagnosis is straightforward as there is gross defor- mity

3. The circulation in the foot must be examined because the

popliteal artery may be torn or obstructed.

Dislocation of knee

• Clinical Features1. the films occasionally reveal a fracture of the tibial spine or

posterior part of the plateau (cruciate ligament avulsion),

2. avulsion of the fibular styloid or avulsion of a fragment from

the near the edge of the lateral tibial condyle (the Segond

fracture).

Treatment

• Reduction under anaesthesia is urgent

• this is usually achieved by pulling directly in the line of the

leg,

• but hyperextension must be avoided because of the dan-

ger to the popliteal vessels.

• the limb is rested on a back-splint and the circulation is

checked repeatedly during the 48 hours.

Complication

• EarlyArterial damageNerve Injury• LateJoint instabilityStiffness

Dislocation of Patella

• If the dislocation has reduced spontaneously, the knee may be swollen and there may be bruising and tenderness on the medial side.

• If the dislocation has reduced spontaneously, the knee may be swollen and there may be bruising and tenderness on the medial side.

IMAGING

• Anteroposterior, lateral and tangential (‘skyline’) x-ray views are needed.

• MRI may reveal a soft-tissue lesion (e.g. disruption of the medial patellofemoral ligament) as well as artic- ular cartilage and/or bone damage.

TREATMENT

• In most cases the patella can be pushed back into place without much difficulty and anaesthesia is not always necessary

• the exception is an intra-articular (intercondylar) dislocation, which may need open reduction.

• If there are no signs of soft tissue rupture – i.e. there is minimal swelling, no bruising and little ten- derness – cast splintage alone will usually suffice.

TREATMENT

• The cast is retained for 2 or 3 weeks and the patient then undergoes a long period (2–3 months) of quadriceps strengthening exercises.

Complication

• Recurrent dislocation : 15–20 per cent chance of suffering further dislocations

Imaging

PERONEAL DISLOCATION

• Acute dislocation of the peroneal tendons may accom- pany – or may be mistaken for – a lateral ligament strain.

• Recurrent subluxation or dislocation is unmistak- able; the patient can demonstrate that the peroneal tendons dislocate forwards over the fibula during dor- siflexion and eversion.

PERONEAL DISLOCATION

• Treatment in a below- knee cast for 6 weeks will help in a proportion of cases; the remainder will complain of residual symptoms.

PERONEAL DISLOCATION