Dislocations

Description:

Dislocation — disturbance of congruence of joint surfaces of bones, both with disturbance of integrity of the joint capsule, and without disturbance, under the influence of mechanical forces (injury) or destructive processes in a joint (arthroses, arthritises).

Symptoms of Dislocations:

Dislocation can be full (full discrepancy of the joint ends) and incomplete — an incomplete dislocation (joint surfaces remain in partial contact). A part of an extremity is considered dislocated distal (distant from a trunk).

Exceptions make:

  1. the backbone — dislocated is considered an overlying vertebra.
  2. a clavicle (distinguish dislocations of the sternal and acromial end of a clavicle, but not dislocation of a shovel).
  3. a shoulder distinguish front and back. Depending on parallagmas.

Reasons of Dislocations:

Inborn dislocations. Such damages result from the wrong pre-natal fetation — an underdevelopment of a joint hollow and a head of a hip (dysplasia). Congenital dislocations of hip joints are more often noted (2-5 on 1000 newborns), is more rare — dislocations of a patella, a knee joint. At the baby dislocation of a hip is shown by asymmetry of folds on the internal surface of hips, restriction of assignment of a leg, etc.; when the child starts walking later — lameness and relative shortening of one lower extremity, at bilateral dislocation — "duck" gait. Congenital dislocation of a patella is shown by pains, a full immovability of a joint, its inflammation, a hemarthrosis; children badly go, often fall. Treatment of congenital dislocation of a hip (reposition, imposing of special tires or plaster bandages) has to begin as soon as possible — yields the best results at children of 3 months, but it is possible also up to 2 years. At futility of such treatment in 2-4 years — surgery. Prevention: orthopedic inspection of newborns. It is impossible to swaddle hardly (and the more so to twist), to violently straighten legs, to prematurely put the child (earlier, than the child will get up on legs itself).
The acquired dislocations. They arise at an injury — traumatic or at diseases (osteomyelitis, poliomyelitis, etc.) - pathological, or spontaneous.

Traumatic dislocations in most cases occur under the influence of an indirect injury when the place of application of force is remote from the injured joint (for example, when falling on a brush of an outstretched arm there is dislocation in a shoulder joint). The sharp reduction of muscles causing the movement which is going beyond normal mobility of this joint (for example, mandible dislocation can be the cause of traumatic dislocation at excessive opening of a mouth). There are dislocations from a direct injury much less often — blow to the area of a joint. At children at the age of 1-3 years the so-called "dislocations from a pulling" arising in joints (humeral, elbow) from sharp breakthrough of the child by a hand are observed (when it is conducted for the handle and it stumbled). Are shown by severe pains in a joint, deformation, disturbance or loss of movements.

At dislocations there is almost always a rupture of the capsule of joints, sinews, muscles, bones, vessels and nerves can be injured; such dislocations are called complicated. Dislocations can be closed — without injury of skin over a joint and open when the wound getting into a joint cavity is formed. Sometimes owing to considerable stretching of a joint bag and sheaves at dislocation, and also without the correct treatment of dislocation arises even at small effort again. It is so-called habitual dislocation (the most frequent in a shoulder joint).

Pathological dislocation arises in coxofemoral and humeral joints usually as a result of destruction of joint surfaces owing to pathological process more often; paralytic dislocation is observed at paralysis or paresis of the muscles surrounding a joint. These dislocations arise without noticeable application of external force, is as if spontaneous, for example, during walking, turning in a bed, etc.

Treatment of Dislocations:

First aid. Fixing of the injured extremity a kerchief, the tire, etc. (immobilization). Cold on area of defeat. Small dislocations can be set independently if there is a confidence in lack of injury of bones. Reposition is performed back to the injury mechanism. Reposition of the joint ends is made only by the doctor in order to avoid additional traumatization of fabrics at once after establishment of the diagnosis with the subsequent immobilization; further — functional treatment (gymnastics, massage etc.). At chronic dislocations (3 weeks after damage) — surgery. At pathological dislocations — treatment of the disease which led to dislocation. Surgery is sometimes necessary for recovery of function.
Ways of reposition.
Reposition of dislocation of subjects is simpler, than the joint more small set. There are some of the most widespread techniques of reposition of dislocations. For an example we will consider shoulder dislocation as one of the most widespread injuries of this type.

    * Hippocrates's way — Cooper.
    * Kokher's way.
    * Dzhanelidze's way.

In general all these methods are directed to recovery of a ratio of bones in a joint due to repetition upside-down to a way which there passed the dislocated bone. That is if dislocation of a shoulder occurred owing to falling on the unbent hand and the humeral bone was displaced up and medially, then for reposition of dislocation the doctor applies force so that the bone was displaced down and lateralno, that is repeated the way upside-down.

Reposition of dislocation of a hip is difficult feasible without use of muscle relaxants, or presence of one-two physically strong assistants. Muscular group around a hip joint most a massivna that considerably complicates reposition.