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Lower limb dislocations (Hip (Posterior (Management (Initial ABCDE,…
Lower limb dislocations
Hip
Posterior
Pathophysiology
Major trauma often with other injuries
e.g. femoral shaft fracture, acetabular fracture
Clinical presentation
Shortened, internally rotated leg
Often associated femoral shaft fracture
Diagnosis
History - major trauma
Examination - hip exam, neurovascular exam
Investigations - pelvic XR (AP, lateral)
Management
-
Definitive
Conservative - ortho referral ASAP
Medical - analgesia
Surgical - Allis reduction under GA,
with XR confirmation
Complications
Sciatic nerve injury (sensation loss, foot drop)
Avascular necrosis of femoral head
Secondary OA
Anterior
-
Diagnosis
History - trauma
Examination - hip exam, neurovascular exam
Investigations - pelvic XR
-
Central
Pathophysiology
Serious pelvic fracture - femur head driven into acetabulum
Serious fall or force driven along femur e.g. dashboard injury
-
-
Prosthetic
Pathophysiology
Common, often minor trauma
Usually posterior dislocation
Clinical presentation
Usually posterior - shortened, int rotated leg
-
Patella
Diagnosis
History - pain, may have recurrent dislocations
Examination - knee exam (if dislocated will have
flexed knee, visibly disloc patella; if reduced, will be
tender around patella and apprehension test +ve)
Investigations - X-ray (AP and lateral)
Management
-
Definitive
Conservative - ortho referral ASAP, physiotherapy
Medical - analgesia
Surgical - reduction under Entonox,
post-reduction X-rays, POP casting
Follow up - orthopedic outpatient clinic
Pathophysiology
Medial knee stress and lateral dislocation
May reduce spontaneously, but may have
patella subluxation due to damage of vastus medialis
Clinical presentation
Dislocated: knee pain, flexed knee, dislocated patella
Spontaneous reduction: tender knee
Knee
Pathophysiology
Rare
Disruption of ligaments and soft tissue
Often associated injury e.g. femur fracture
May have popliteal artery/nerve damage
Clinical presentation
Knee pain, deformity
Diagnosis
History - trauma
Examination - knee, neurovascular
Investigations - knee XR, CT (soft tissue)
Management
-
Definitive
Conservative - ortho referral ASAP
Medical - analgesia
Surgical - reduction, repair,
check neurovascular, POP backslab
Ankle
Clinical presentation
Gross deformity, skin stretching,
cold, reduced sensation
Diagnosis
History - trauma
Examination - ankle/foot (defomity, neurovascular)
Investigations - ankle XR
Pathophysiology
Orthopedic emergency
Often associated with fractures
Deformity and skin stretching can
lead to blisters, necrosis and compound fracture
Management
-
Definitive
Conservative - ortho referral ASAP
Medical - analgesia
Surgical - reduction under GA/entonox,
post-reduction analgesia, neurovascular check,
immobilise in POP backslab
Foot
Types
Talar
Clinical presentation
Pain, foot deformity
Diagnosis
History - trauma
Exam - foot/ankle exam, neurovascular
Investigations - Foot/ankle XR, CT
Pathophysiology
Falls onto feet, violent dorsiflexion
Can result in avascular necrosis
Management
Conservative - ortho referral
Medical - analgesia
Surgical - MUA, ORIF, reduction
Upper/midfoot
Diagnosis
History - trauma
Exam - foot/ankle, neurovascular
Investigations - ankle XR, CT
-
Pathophysiology
Violent twisting, inverting or everting
Peritalar/subtalar - talus-calcaneal joint
Midtarsal - midtarsal joint (talus, calcaneus, navicular, cuboid)
Metatarsal
Pathophysiology
Heavy objects/vehicle run over
Tarsal-metatarsal (Lisfranc) dislocation
Often associated with fractures
Clinical presentation
Pain, deformity
Diagnosis
History - crush trauma
Exam - foot/ankle, neurovascular
Investigations - ankle XR (may not be seen easily)
Management
Conservative - ortho referral ASAP
Medical - analgesia
Surgical - MUA, K-wires, ORIF,
POP backslab immobilisation
-
-
Toes
Clinical presentation
Pain, deformity, swelling
-
Pathophysiology
Trauma, often associated
fractures/soft tissue injury
Management
Conservative - ortho ref ASAP,
elevation, gradual mobilisation
Medical - analgesia
Surgical - reduction under LA
digital block and buddy strapping