Dislocation

By degree of bias

A dislocation can be complete (complete divergence of the articular ends) and incomplete - a subluxation (articular surfaces remain in partial contact). Dislocated is the distal (farthest from the body) part of the limb.

The exceptions are:

1. spine - an overlying vertebra is considered to be dislocated.
2. clavicle (distinguish dislocations of the sternal and acromial end of the clavicle, but not dislocation of the scapula ).

By origin

Distinguish between congenital and acquired dislocations.

Congenital

Such injuries result from abnormal fetal development - underdevelopment of the articular cavity and femoral head ( dysplasia ). Congenital dislocations of the hip joints (2–5 per 1000 newborns) are more often noted, less often - dislocations of the patella , knee joint . In a baby, hip dislocation is manifested by an asymmetry of folds along the inner surface of the hips, limitation of leg abduction, etc. when the child begins to walk and later - with lameness and relative shortening of one lower limb, with bilateral dislocation - “duck” gait. Congenital dislocation of the patella is manifested by pain, complete immobility of the joint, its inflammation, hemarthrosis; children walk poorly, often fall. Treatment of congenital dislocation of the hip (reduction, application of special tires or plaster dressings) should begin as early as possible - gives the best results in children 3 months, but possibly up to 2 years. With the failure of such treatment in 2-4 years - a surgical operation. Prevention: orthopedic examination of newborns. It is impossible to swaddle tightly (and even more so to twist), forcefully straighten the legs, prematurely place the child (before the child stands on his own feet).

Acquired

They occur with trauma - traumatic or with diseases ( osteomyelitis , polio , etc.) - pathological, or spontaneous.

In most cases, traumatic dislocations occur under the influence of an indirect injury, when the place of application of force is distant from the damaged joint (for example, when an outstretched arm falls on the wrist, a dislocation occurs in the shoulder joint). The cause of a traumatic dislocation can be a sharp contraction of the muscles, causing a movement that goes beyond the normal mobility of a given joint (for example, a dislocation of the lower jaw with excessive opening of the mouth). Dislocations from a direct injury are much less likely to occur - a blow to the joint area. In children aged 1-3 years, the so-called “elongations from elongation” are observed, arising in the joints (shoulder, elbow) from a sharp jerking of the child’s hand (when he is led by the handle and he stumbled). They are manifested by severe pain in the joint area, deformation, disturbance or loss of movement.

With dislocations, the capsule of the joints almost always ruptures, tendons , muscles , bones , vessels and nerves can be damaged; such dislocations are called complicated. Dislocations can be closed - without damaging the skin over the joint and open when a wound penetrates the joint cavity. Sometimes due to significant stretching of the joint bag and ligaments with dislocation, as well as without proper treatment, dislocation arises again even with a little effort. This is the so-called habitual dislocation (the most common in the shoulder joint).

Pathological dislocation occurs in the joints usually as a result of the destruction of the articular surfaces due to the pathological process; paralytic dislocation is observed with paralysis or paresis of the muscles surrounding the joint. These dislocations occur without a noticeable application of external force, as if spontaneously, for example, while walking, turning in bed, etc.

First Aid

Fixation of a damaged limb with a scarf, tire, etc. ( immobilization ). Cold on the affected area. Small dislocations can be corrected independently if there is confidence in the absence of damage to the bones. Reduction is performed back to the injury mechanism. Reduction of the articular ends is done only by a doctor in order to avoid additional tissue trauma immediately after a diagnosis is established with subsequent immobilization; in the future - functional treatment ( gymnastics , massage , etc.). In case of chronic dislocations (3 weeks after damage) - surgery. In case of pathological dislocation - treatment of the disease that led to the dislocation. Surgery is sometimes necessary to restore function.

Methods of Government

The direction of dislocation is the easier, the smaller the joint being adjusted. There are some of the most common techniques for relieving dislocations. For example, consider shoulder dislocation as one of the most common injuries of this type.

• The Hippocratic - Cooper Way.
• Kocher method.
• Way Janelidze .

In general, all these methods are aimed at restoring the ratio of bones in the joint by repeating in the reverse order the path that the dislocated bone went through. That is, if a shoulder dislocation occurred as a result of a fall on an unbent arm and the humerus has shifted upward and medially, then to correct the dislocation the doctor applies force so that the bone is displaced downward and laterally, that is, she repeated her path in the reverse order.

Reducing hip dislocation is difficult without muscle relaxants , or one or two physically strong assistants. The muscle group around the hip joint is the most massive, which makes it difficult to reduce.

The procedure for rehabilitation measures is determined by the doctor, depending on the severity of the injury. As a rule, physiotherapy is prescribed. Acupuncture, microwave radiation, and muscle massage with electric discharges are prescribed. A full course of treatment should be taken. In a typical case, in order to return the joint to normal condition, it takes no more than a month. Professional athletes require longer treatment.

The prognosis of the disease is favorable. With adequate therapy, a complete recovery of disability occurs.

• Hippocratic - Cooper Mode
• Kocher Method
• Way Janelidze

• Bone dislocation // Brockhaus and Efron Encyclopedic Dictionary : in 86 volumes (82 volumes and 4 additional). - SPb. , 1890-1907.
• POLYAKOV V.A. Selected lectures on traumatology. M .: Medicine, UDC 617—001 (081) 1980, 272 pp., Ill.
• Petrov S.V. General Surgery: Textbook for high schools. - 2nd edition. - 2004 year. - 768 p. - ISBN 5-318-00564-0 .