Orthopedic Dislocations (Shoulder, Elbow and Hip) - Diagnosis and Management Summary
• Fall on the out stretch hand with rotation
• Posterior dislocation (due to internal rotation)
• Anterior dislocation (due to external rotation of ABDucted arm)
Shoulder Reduction Methods:
A. Hippocratic method
1. The patient lies supine.
2. The physician's foot is placed in the patient's axilla against the chest wall while leaning backward.
3. Slow, steady and gentle longitudinal traction is applied to the affected arm in 30-40° abduction for about one minute.
4. The foot acts as a counterforce and as a lever to push the humeral head laterally while the physician pulls the head toward the patient's foot along the surface of the glenoid, effectively adducting the affected arm.
5. Put patient on arm sling
B. Kocher method
T – Traction in line of humerus
E – External Rotation of humerus
A – Adduction of arm
M – Medial rotation
• Fall on outstretched hand with elbow slightly flexed
• Types: Posterior (most common), Anterior, Lateral, Medial Divergent
• Elbow Reduction: Dislocation reducing the dislocation by traction and pressure flexing the elbow fully as a test of reduction immobilizing the limb in an above-elbow plaster slab (margin shown by dotted line) and a sling.
Usually occurs in an MVA as a result of dash board injury
Hip Reduction Methods (SHOULD BE DONE ASAP TO REDUCE THE CHANCE OF AVN OF HEAD):
A. Bigelow method: FLEX, ABDUCT, EXTERNAL ROTATION, EXTENSION, NEUTRAL ROTATION
B. Allis method
1. The patient is supine
2. Affected hip and knee are flexed in 90 degree
3. In neutral rotation of hip, an upward traction is applied along the axis of femur and the same counter traction is given by holding the pelvis.
C. Stimsons’ gravity method: The patient is laid prone with the lower limb hanging over the other end of the table. Femoral head is pushed down into the acetabulum and at the same time the traction is applied downward along the axis of femur
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