joint dislocations
DESCRIPTION
kuliah dislokasi sendi blok muskuloskeletal dan integumen fakultas kedokteran unramTRANSCRIPT
JOINT DISLOCATIONSJOINT DISLOCATIONS
Dr.rudi febrianto Sp.OT
JOINT DISLOCATIONSJOINT DISLOCATIONS
DefinitionDefinition A dislocation is a separation of two bones A dislocation is a separation of two bones
where they meet at a joint. A dislocated where they meet at a joint. A dislocated bone is no longer in its normal position. A bone is no longer in its normal position. A dislocation may also cause ligament or dislocation may also cause ligament or nerve damage. Dislocations may be nerve damage. Dislocations may be associated with a periarticular fractureassociated with a periarticular fracture
A subluxation is an incomplete or partialdislocation. For example, anursemaid's elbow is the subluxation of the head of the radius in the elbow.
SUBLUXATIONSUBLUXATION
DISLOCATION CAUSESDISLOCATION CAUSES
Dislocations are usually caused by a Dislocations are usually caused by a sudden impact to the joint. This sudden impact to the joint. This usually occurs following a blow, fall, usually occurs following a blow, fall, or other traumaor other trauma
Predisposing factor of Predisposing factor of dislocationdislocation
Susceptibility to fallSusceptibility to fall HeredityHeredity Sport participationSport participation Motor vehicle accidentMotor vehicle accident
DISLOCATION SYMPTOMSDISLOCATION SYMPTOMS
History of injuryHistory of injury Pain Pain SwellingSwelling Difficulty moving the jointDifficulty moving the joint Numbness and paresthesiasNumbness and paresthesias
DISLOCATION SIGNSDISLOCATION SIGNS
Visibly out-of-place, discolored, or misshapen joint
Limited joint movement Swollen or bruised Intensely painful, especially if you try
to use the joint or bear weight on it or move it.
Decreased sensation distal to the joint Decreased pulse, cool extremity distal
to the joint
NOMENCLATURE FOR NOMENCLATURE FOR DISLOCATIONSDISLOCATIONS
Name the Name the JOINTJOINT Name the dislocation by the position Name the dislocation by the position
of the of the DISTAL FRAGMENTDISTAL FRAGMENT in in relation to the proximal fragmentrelation to the proximal fragment
Add Add FRACTUREFRACTURE to the name if to the name if there is a periarticular fracture.there is a periarticular fracture.
Add Add OPENOPEN if a wound if a wound communicates with the dislocationcommunicates with the dislocation
RADIOGRAPHSRADIOGRAPHS
Two planes at 90 Two planes at 90 degrees to each degrees to each otherother
Good qualityGood quality Standard viewsStandard views See the entire jointSee the entire joint
Dislocated Elbow
TREATMENTTREATMENT
Reduce the dislocation as soon as Reduce the dislocation as soon as possiblepossible
Check Neurovascular function distallyCheck Neurovascular function distally Take post reduction radiographTake post reduction radiograph Immobilize the jointImmobilize the joint
REDUCTION TECHNIQUEREDUCTION TECHNIQUE
Start IVStart IV Give sedationGive sedation Apply traction forceApply traction force Manipulate jointManipulate joint
Posterior dislocation of Posterior dislocation of ElbowElbow
Fall on the hand with elbow slightly Fall on the hand with elbow slightly flexed or severe hyperextension injuryflexed or severe hyperextension injury
Clinical feature : humerus driven Clinical feature : humerus driven forward througt anterior capsule, there forward througt anterior capsule, there is always extensive soft tissue injury, is always extensive soft tissue injury,
Elbow is grossly swollen, olecranon is Elbow is grossly swollen, olecranon is readly palpable posteriorlyreadly palpable posteriorly
Complication : median nerve injury, Complication : median nerve injury, elbow stiffness, myositis ossificationelbow stiffness, myositis ossification
Reduction techniqueReduction technique
Reduction techniqueReduction technique
Shoulder dislocationShoulder dislocation
Anterior or posterior dislocationAnterior or posterior dislocation Shoulder joint is dependent stability Shoulder joint is dependent stability
on the joint capsule and surrounding on the joint capsule and surrounding musclemuscle
The glenoid cavity being small in The glenoid cavity being small in relation to head of humerusrelation to head of humerus
Anterior dislocation of Anterior dislocation of shouldershoulder
Incident is 95% of all dislocation of Incident is 95% of all dislocation of shouldershoulder
Caused by forced external rotation and Caused by forced external rotation and extension of shoulderextension of shoulder
Humeral head driven forward and Humeral head driven forward and frequently avulses the cartilagenous frequently avulses the cartilagenous glenoid labrum and capsule from anterior glenoid labrum and capsule from anterior margin of the glenoid cavitymargin of the glenoid cavityThe bankart The bankart lesionlesion
Patient immediately aware Patient immediately aware
TreatmentTreatment– prone position in 10 minute wait until prone position in 10 minute wait until
spontaneous reposition to normalspontaneous reposition to normal– Hippocrates techniqueHippocrates technique– Reduction with general anesthesia Reduction with general anesthesia
ComplicationComplication– RecurrentRecurrent– Traction injury of axillary nerveTraction injury of axillary nerve
SHOULDER REDUCTIONSHOULDER REDUCTION
SedationSedation Apply traction and Apply traction and
counter tractioncounter traction Lift humeral head Lift humeral head
into the glenoidinto the glenoid
Posterior dislocation of Posterior dislocation of shouldershoulder
posterior dislocation of the posterior dislocation of the hiphip
Dashboard injury or fall on the knee flexedDashboard injury or fall on the knee flexed Usually jeopardize blood supply to femoral Usually jeopardize blood supply to femoral
headheademergency and need to reduce as emergency and need to reduce as soon as possible to prevent avascular soon as possible to prevent avascular necrosisnecrosis
To lower incident of avascular necrosis To lower incident of avascular necrosis need to be reduced in first 8 hoursneed to be reduced in first 8 hours
Clinical feature : hip in flexion, adduction, Clinical feature : hip in flexion, adduction, internal rotation and shortening internal rotation and shortening
X-ray : femoral head lies well above the X-ray : femoral head lies well above the acetabulumacetabulum
Hip reductionHip reduction
Hip reductionHip reduction
HIP REDUCTIONHIP REDUCTION
SedationSedation Relaxation, Relaxation,
flexion, traction, flexion, traction, and rotationand rotation
Gentle and Gentle and atraumaticatraumatic
Relocation should be palpable and permit significantly improved ROM. This often requires very deep sedation.
Anterior dislocation of the Anterior dislocation of the hiphip
Ankle dislocationAnkle dislocation
PIPJ DISLOCATIONPIPJ DISLOCATION
Hyper-extend the joint, apply traction then flex the joint. Follow with a post reduction x-ray, check for avulsion fracture.
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