TRAUMATOLOGY.TRAUMATOLOGY.FRACTURES AND FRACTURES AND DISLOCATIONS.DISLOCATIONS.

TraumaTrauma is influence on the organism of is influence on the organism of outward agents (mechanic, thermal, outward agents (mechanic, thermal, electric, ray, psychical and oth.), which electric, ray, psychical and oth.), which provoked the anatomical and functional provoked the anatomical and functional breaches in the organs and tissues, which breaches in the organs and tissues, which are accompanied by local and general are accompanied by local and general reaction of organism reaction of organism

There are distinguished the There are distinguished the following types of traumatism:following types of traumatism:

1. Traumas of unindustrial character:1. Traumas of unindustrial character: a) transport traumas (railway, car, tram);a) transport traumas (railway, car, tram); b) everyday;b) everyday; c) sporting;c) sporting; d) others (traumas, which received as a result d) others (traumas, which received as a result

of natural catastrophes).of natural catastrophes).2. Traumas of industrial character (manufactural 2. Traumas of industrial character (manufactural

and agricultural).and agricultural).3. Intentional traumas (battle traumas, ill-3. Intentional traumas (battle traumas, ill-

intentioned attacks, attempt of suicide).intentioned attacks, attempt of suicide).Traumas are divided on mechanic, chemical, Traumas are divided on mechanic, chemical,

electric, ray, psychical, operational and electric, ray, psychical, operational and others by a type provoked the damage others by a type provoked the damage agent.agent.

The dividing of traumas by character of The dividing of traumas by character of damage is very important - there are damage is very important - there are distinguished the open and closed distinguished the open and closed traumas. There is a gaping of skin and traumas. There is a gaping of skin and mucous membranes wounds by the open mucous membranes wounds by the open damages. The microbes can penetrate damages. The microbes can penetrate through the wound of skin and mucous, through the wound of skin and mucous, that is promote to developmental of early that is promote to developmental of early and later complications. There are also and later complications. There are also distinguished the penetrating damages, in distinguished the penetrating damages, in the presence of which the internal organs the presence of which the internal organs (of abdomen, of thorax, of skull, of joints) (of abdomen, of thorax, of skull, of joints) can be affected, and unpenetrating.can be affected, and unpenetrating.

In the damages of tissue of only of only one In the damages of tissue of only of only one type we tell about the simple trauma, if type we tell about the simple trauma, if the different tissues are damaged - about the different tissues are damaged - about the complex trauma, for example, the the complex trauma, for example, the skin, muscles and bone.skin, muscles and bone.

Traumas can be direct and undirect Traumas can be direct and undirect (damages developing in the distance (damages developing in the distance from the region of provoking agent from the region of provoking agent influence).influence).

Peculiarities of investigations of Peculiarities of investigations of traumatological patients.traumatological patients.

At first, the outward look of damaged place not At first, the outward look of damaged place not always corresponds to the seriousness of damage.always corresponds to the seriousness of damage.

Secondly, not always the trauma, symptoms of Secondly, not always the trauma, symptoms of which are obvious, is threating for human life, which are obvious, is threating for human life, especially hard the diagnostic of plurality traumas especially hard the diagnostic of plurality traumas of patients, which are unconscious, in a state of of patients, which are unconscious, in a state of serious shock or alcoholic intoxication.serious shock or alcoholic intoxication.

Thirdly, the serious general phenomena (shock, Thirdly, the serious general phenomena (shock, acute anemia, traumatic toxicosis) can appearance acute anemia, traumatic toxicosis) can appearance by traumas. It is necessary to estimate them rightly by traumas. It is necessary to estimate them rightly and render the proper help.and render the proper help.

It is necessary to elucidate by It is necessary to elucidate by questioning of victim (or eye-witnesses, questioning of victim (or eye-witnesses, if the patient is unconscious) the if the patient is unconscious) the complaints in present time, what the complaints in present time, what the patient felt at the moment of trauma patient felt at the moment of trauma and then, what help has rendered to it. and then, what help has rendered to it. It is necessary to determine the It is necessary to determine the presenting accompanying diseases.presenting accompanying diseases.

It is necessary to examine the place of damage It is necessary to examine the place of damage that is far specification of diagnosis and to that is far specification of diagnosis and to represent the preliminary opinion about the represent the preliminary opinion about the methods of treatment and possible methods of treatment and possible complications. For example, the fractures can be complications. For example, the fractures can be accompanied by damage of nerve and great accompanied by damage of nerve and great vessels, and the wound of thorax is complicated vessels, and the wound of thorax is complicated by hemothorax and heart tamponade. Getting of by hemothorax and heart tamponade. Getting of a soil in the wound can provoke the tetanus a soil in the wound can provoke the tetanus later. To check the condition of all systems and later. To check the condition of all systems and organs, estimate the presence of general organs, estimate the presence of general phenomena and degree of them seriousness. phenomena and degree of them seriousness. Carry out the laboratory and roentgenological Carry out the laboratory and roentgenological investigations, if they not prevent to rendering of investigations, if they not prevent to rendering of urgent help. It is necessary to take into account urgent help. It is necessary to take into account the anatomical, comparative and functional the anatomical, comparative and functional shortening of extremity and middle-physiological shortening of extremity and middle-physiological location of upper and lower extremities.location of upper and lower extremities.

Closed damages in soft Closed damages in soft tissues.tissues.

Closed damages of soft tissues Closed damages of soft tissues are divided on contusions, are divided on contusions, tensions and ruptures, tensions and ruptures, concussions and squeezes. concussions and squeezes. Closed damages of soft tissues, Closed damages of soft tissues, organs, which localized in organs, which localized in cavities are observed.cavities are observed.

ContusionContusion

ContusionContusion - (contusio) - is damage of tissues - (contusio) - is damage of tissues and organs without the breach of skin integrity and organs without the breach of skin integrity as a result of quick and momentary action of as a result of quick and momentary action of traumating factor on the one or another part of a traumating factor on the one or another part of a human body. Mechanism of the trauma can be human body. Mechanism of the trauma can be various - fall on something object or blow.various - fall on something object or blow.

Seriousness of damage is determined by two Seriousness of damage is determined by two moments:moments:

1. Character of traumating agent, its 1. Character of traumating agent, its seriousness, consistence, quickness of action.seriousness, consistence, quickness of action.

2. Type of tissues, on which the trauma act 2. Type of tissues, on which the trauma act (skin, muscles, fat, bones).(skin, muscles, fat, bones).

Clinical pictureClinical picture - characterized by appearance of - characterized by appearance of pains, swelling, breach of function of contusioned pains, swelling, breach of function of contusioned organ or region. It can be observed the exfoliation organ or region. It can be observed the exfoliation of skin by the action of great force by (angent, it of skin by the action of great force by (angent, it can develope the shock of paralysis (be contusion can develope the shock of paralysis (be contusion of great nerves) of a region, which innervated by of great nerves) of a region, which innervated by contusioned nerve, by contusion of joint breach of contusioned nerve, by contusion of joint breach of its function, by contusion of thorax and lung - its function, by contusion of thorax and lung - cutaneous emphysema.cutaneous emphysema.

TreatmentTreatment. Solution of treatment at first period . Solution of treatment at first period after contusion is stopping of hemorrhage in after contusion is stopping of hemorrhage in tissues, that achieved by quarantee of rest, raised tissues, that achieved by quarantee of rest, raised posture, cold, pressing bandage. On 2-3 day when posture, cold, pressing bandage. On 2-3 day when the contusioned vessels thrombosed, the warmth, the contusioned vessels thrombosed, the warmth, physiotherapy procedures are applied. In the physiotherapy procedures are applied. In the presence of haematoma sucking off and presence of haematoma sucking off and introduction of antibiotics.introduction of antibiotics.

TensionsTensions (distorsio) (distorsio)Tensions is damage of soft tissues, which is Tensions is damage of soft tissues, which is

provoked by the force acting like a tractio n and provoked by the force acting like a tractio n and nor breaching the continuity of tissues. However, nor breaching the continuity of tissues. However, if the acting force exceed the resistibility of if the acting force exceed the resistibility of tissues by such mechanism of trauma, then the tissues by such mechanism of trauma, then the rupture of ligaments, fascias, muscles, tendons, rupture of ligaments, fascias, muscles, tendons, nerves etc. Clinically the eupture of ligaments is nerves etc. Clinically the eupture of ligaments is accompanied by appearance of strong pains, accompanied by appearance of strong pains, breach of motions, haemorrhages in soft tissues, breach of motions, haemorrhages in soft tissues, oedema, swelling of joint. It can be determined oedema, swelling of joint. It can be determined the fluctuation by a palpation as a result of the fluctuation by a palpation as a result of haemorrhages.haemorrhages.

Treatment consists in quarantee of a rest, Treatment consists in quarantee of a rest, application of pressing bandage, prolonged application of pressing bandage, prolonged immobilization of a joint. After resilution of immobilization of a joint. After resilution of haemorrhage with third week, they pass to the haemorrhage with third week, they pass to the careful active movements, massage, and medical careful active movements, massage, and medical physical training. The punctions and introduction physical training. The punctions and introduction of antibiotics are by delated resolution.of antibiotics are by delated resolution.

RupturesRuptures

Ruptures Ruptures of fascies are registered rarely and developed of fascies are registered rarely and developed from the direct blow in a region of fascia. The crack-like from the direct blow in a region of fascia. The crack-like defect of fascia appeared as a result, that is lead to sticking defect of fascia appeared as a result, that is lead to sticking out by the contraction of muscles.out by the contraction of muscles.

Treatment - operative.Treatment - operative.Ruptures of muscles - complete and uncomplete are Ruptures of muscles - complete and uncomplete are

registered rarely and happened as a result of strong and registered rarely and happened as a result of strong and quick contraction of them, by rising of heavinesses. The quick contraction of them, by rising of heavinesses. The strong pains, haemorrhages, oedema, limits in motion are strong pains, haemorrhages, oedema, limits in motion are manifested clinically.manifested clinically.

Treatment - by uncomplete rupture - immobilization, rest, Treatment - by uncomplete rupture - immobilization, rest, cold, then the warmth, physioprocedures. By complete cold, then the warmth, physioprocedures. By complete rupture - operation with following immobilization on 2-3 rupture - operation with following immobilization on 2-3 weeks.weeks.

Ruptures of tendons need the operation.Ruptures of tendons need the operation.Concussions (commotio) - is lead to the significant Concussions (commotio) - is lead to the significant

breaches of function of organs and tissues. Prolonged and breaches of function of organs and tissues. Prolonged and strong vibration of upper extremities at first provoked the strong vibration of upper extremities at first provoked the breach of functions, and then lead to the morphological breach of functions, and then lead to the morphological changes in muscles, nerves, bones, which are expressed in a changes in muscles, nerves, bones, which are expressed in a development of sclerotic processes, pains, limit of capacity development of sclerotic processes, pains, limit of capacity for work (vibrational disease).for work (vibrational disease).

SqueezeSqueeze

SqueezeSqueeze - is observed by - is observed by squeeze of lifly important squeeze of lifly important organs (heart, brain, organs (heart, brain, lungs).lungs).

Fractures of bones and dislocations. Fractures of bones and dislocations. Clinic, treatment.Clinic, treatment.

Fracture.Fracture. A fracture is a structural break in the normal A fracture is a structural break in the normal continuity of bone. This structural break, and hence fracture, continuity of bone. This structural break, and hence fracture, may also occur through cartilage, epiphysis and epiphysal plate may also occur through cartilage, epiphysis and epiphysal plate (see appendix 14).(see appendix 14).

Dislocation.Dislocation. A dislocation is a total disruption of a joint with A dislocation is a total disruption of a joint with partial remaining, but abnormal, contact between the articulating partial remaining, but abnormal, contact between the articulating surfaces.surfaces.

Subluxation.Subluxation. A subluxation is a partial disruption of a joint with A subluxation is a partial disruption of a joint with partial remaining, but abnormal, contact between the articulating partial remaining, but abnormal, contact between the articulating surfaces.surfaces.

The treatment of fractures and dislocations requires The treatment of fractures and dislocations requires knowledge of the anatomy, physiology, and biomechanics of the knowledge of the anatomy, physiology, and biomechanics of the musculoskeletal system. While a fracture represents a disruption musculoskeletal system. While a fracture represents a disruption in thecontinuity of a bone, it also represents a major soft tissue in thecontinuity of a bone, it also represents a major soft tissue injury. The fracture surgeon must be aware of the soft tissue injury. The fracture surgeon must be aware of the soft tissue structures adjacent to a fracture site and be alert for neurologic structures adjacent to a fracture site and be alert for neurologic and vascular components of the injury. Since many fractures and vascular components of the injury. Since many fractures occur in a setting of violent trauma, full evaluation of each occur in a setting of violent trauma, full evaluation of each patient is necessary, and the surgeon must be prepared to deal patient is necessary, and the surgeon must be prepared to deal with major onjures in other tissue systems.with major onjures in other tissue systems.

FractureFracture FractureFracture - is a partial or total breach of - is a partial or total breach of

integrity of the bone, which is provoked by integrity of the bone, which is provoked by quickly - acting force and accompanied damage quickly - acting force and accompanied damage of soft tissues. The fractures are divides on of soft tissues. The fractures are divides on inborn and acquired depending on the origin. inborn and acquired depending on the origin. Each of these groups, in one's turn, divided on Each of these groups, in one's turn, divided on open and closed, and the acquired fractures are open and closed, and the acquired fractures are divided on traumatic and pathological. divided on traumatic and pathological.

Open fractures are accompanied by damage Open fractures are accompanied by damage of integrity of soft tissues and skin integuments. of integrity of soft tissues and skin integuments. Closed - are the fractures, in the presence of Closed - are the fractures, in the presence of which the skin and mucouse areintact andwhich the skin and mucouse areintact and are are the barries for the penetration of infection.the barries for the penetration of infection.

1. By the direct blow - transversal fracture 1. By the direct blow - transversal fracture fracture with a dislocation of peripheral osseous fracture with a dislocation of peripheral osseous piece.piece.

Squeze is lead to a compessional fracture for Squeze is lead to a compessional fracture for example, body of a vertebra by the strong bending, example, body of a vertebra by the strong bending, and by fall.and by fall.

It can be developed the oblique and transversal It can be developed the oblique and transversal fracture be bending.fracture be bending.

The twisting of a bone by fixing one end is lead to The twisting of a bone by fixing one end is lead to the development of helical fracture by spiral.the development of helical fracture by spiral.

The breaking off fractures is happened by the The breaking off fractures is happened by the sharp and strong contraction of muscles.sharp and strong contraction of muscles.

2. By localization the damages are divided on the 2. By localization the damages are divided on the epiphysial fractures are unfavourable for the epiphysial fractures are unfavourable for the processes of consolidation and quite often processes of consolidation and quite often accompanied by dislocation of osseous piece of a accompanied by dislocation of osseous piece of a joint, that is hamper the comparison and fixation of joint, that is hamper the comparison and fixation of osseous parts.osseous parts.

Metaphyseal - are the damages of a Metaphyseal - are the damages of a spongy part of bone. The important spongy part of bone. The important symptoms of a fracture (crepitation, symptoms of a fracture (crepitation, abnormal mobility and others) are abnormal mobility and others) are absent quite often by such fractures.absent quite often by such fractures.

3. The fractures are divided on transversal, 3. The fractures are divided on transversal, oblique, longitudinal, spiral, shrapnel.oblique, longitudinal, spiral, shrapnel.

4. There are total and incomplete 4. There are total and incomplete fractures.fractures.

5. There are simple, complex and 5. There are simple, complex and combined fractures.combined fractures.

6. Single and plural.6. Single and plural.

Formation of a callus.Formation of a callus.It can be divided the pathological It can be divided the pathological

changes the pathological changes by the changes the pathological changes by the fractures and them unions of three periods:fractures and them unions of three periods:

a) changes, which connected directly a) changes, which connected directly with a trauma and development of aseptic with a trauma and development of aseptic inflammation;inflammation;

b) period of osteogenesis;b) period of osteogenesis;

c) period of reconstruction of a callus.c) period of reconstruction of a callus.

The following development of a The following development of a callus is happen by two ways:callus is happen by two ways:

1) by the way of immediate 1) by the way of immediate formation of a callus from osteoid formation of a callus from osteoid tissue.tissue.

2) by the way of preliminary 2) by the way of preliminary formation of hyaline or fibrous formation of hyaline or fibrous cartilage from the osteoid tissue.cartilage from the osteoid tissue.

Regeneration of the bone depend Regeneration of the bone depend on:on:1. Character and force of traumatic agent serious 1. Character and force of traumatic agent serious

trauma make (he less favorable conditions for trauma make (he less favorable conditions for consolidation.consolidation.

2. Anatomy-physiological states. Different bones 2. Anatomy-physiological states. Different bones had various ability to union. Bones are united had various ability to union. Bones are united quicker of young people.quicker of young people.

3. Character of fracture:3. Character of fracture:

a) accompanied by large destruction and breach of a) accompanied by large destruction and breach of nourishment of periosteum;nourishment of periosteum;

b) accompanied by breach of innervation;b) accompanied by breach of innervation;

c) breach of a blood supply;c) breach of a blood supply;

d) fractures in region of bone, which have not the d) fractures in region of bone, which have not the periosteum, for example intraarticulate fractures. periosteum, for example intraarticulate fractures.

Clinic of fracturesClinic of fractures1. Pain - is observed at once after the 1. Pain - is observed at once after the

fracture; it abate in a rest and reinforced fracture; it abate in a rest and reinforced by any movement of extremity. But the by any movement of extremity. But the pain doesn't decisive symptom, because it pain doesn't decisive symptom, because it take place by injuries, tensions.take place by injuries, tensions.

2. The breach function is not always typical 2. The breach function is not always typical symptom of fracture. It is typical, for symptom of fracture. It is typical, for example, for the fracture of lower example, for the fracture of lower extremity that a patient does not stay on extremity that a patient does not stay on the legs after traumathe legs after trauma

3. Sometimes the deformation is acutely 3. Sometimes the deformation is acutely expressed on the place of fracture, and expressed on the place of fracture, and sometimes expressed little and can be sometimes expressed little and can be recognized only on R-gramm.recognized only on R-gramm.

There are some types of displacement:There are some types of displacement:a) Displacement under the angle, when the axws of a) Displacement under the angle, when the axws of

osseous fragments formed the angle of the place osseous fragments formed the angle of the place of fracture. Angle depend on the direction of the of fracture. Angle depend on the direction of the fragments.fragments.

b) Lateral displacement is observed by the b) Lateral displacement is observed by the divergence of osseous fragments in a direction of divergence of osseous fragments in a direction of diameter of the bone.diameter of the bone.

c) Displacement by the length, longitudinal c) Displacement by the length, longitudinal displacement - more often type of displacement, displacement - more often type of displacement, when the one fragment slip along anotherwhen the one fragment slip along another

4. Mobility of osseous fragments along the bone 4. Mobility of osseous fragments along the bone length is very sure sign of the fracture. It can be length is very sure sign of the fracture. It can be expressed well by the diaphysial fractures.expressed well by the diaphysial fractures.

5. Crepitating and abnormal mobility of osseous 5. Crepitating and abnormal mobility of osseous fragments is defined, if the bone fixed by one fragments is defined, if the bone fixed by one hand below and by another hand above the place hand below and by another hand above the place of fracture and does carefully the motion in a of fracture and does carefully the motion in a opposite side.opposite side.

Modern treatment of fractures direct at Modern treatment of fractures direct at restoration of anatomical; structure and restoration of anatomical; structure and physiological structure of a fractural bone. This physiological structure of a fractural bone. This purpose is attained by successive application of purpose is attained by successive application of such measures as:such measures as:

1. setting of osseous fragments - reposition;1. setting of osseous fragments - reposition;

2. retention of them in a right posture (ill the 2. retention of them in a right posture (ill the union -immobilization;union -immobilization;

3. acceleration of the union processes 3. acceleration of the union processes (consolidation) and restoration of function of the (consolidation) and restoration of function of the damaged organ by the way of;damaged organ by the way of;

a) functional treatment with the application of a a) functional treatment with the application of a medical physical training;medical physical training;

b) improvement of a general state of a patient b) improvement of a general state of a patient (nourishment, vitaminization, blood transfusion).(nourishment, vitaminization, blood transfusion).

Success of the reposition depend on Success of the reposition depend on following moments:following moments:

a) knowledge of the type of fracture and a) knowledge of the type of fracture and displacement of central and peripheral displacement of central and peripheral fragments;fragments;

b) by well anasthetization - 2% solution of a b) by well anasthetization - 2% solution of a novocaine in the place of fracture;novocaine in the place of fracture;

c) by relaxation of muscles, which fastened c) by relaxation of muscles, which fastened to the osseous fragments;to the osseous fragments;

d) by right comparison of oseous fragments d) by right comparison of oseous fragments pehpherial is placed to central;pehpherial is placed to central;

e) use of arm methods for reposition and e) use of arm methods for reposition and by reading of different apparatuses by reading of different apparatuses (Sokolovsky', cug-apparatus and others)(Sokolovsky', cug-apparatus and others)

Fixation or immobilizationFixation or immobilization of osseous of osseous fragments ill a right posture can be fragments ill a right posture can be practicable by different methods:practicable by different methods:

a) gypseous bandage;a) gypseous bandage;

b) drawing out;b) drawing out;

c) operation.c) operation.

Gypseous bandages: circulary, longetic, Gypseous bandages: circulary, longetic, longetic-circulary, fenestrated, bridge-longetic-circulary, fenestrated, bridge-like, folding, and gypseous bedstead.like, folding, and gypseous bedstead.

Gypseous bandages, which applied Gypseous bandages, which applied on extremity with already on extremity with already developed traumatic oedema, with developed traumatic oedema, with the hematoma, through 7-14 days the hematoma, through 7-14 days in connection with decrease of in connection with decrease of oedema become free. It is oedema become free. It is necessary to take off it and apply a necessary to take off it and apply a new bandage to avoid the new bandage to avoid the secondary displacement. Gypseous secondary displacement. Gypseous bandage immobilize the extremity bandage immobilize the extremity on date, which is necessary for on date, which is necessary for consolidation.consolidation.

Fig. 1. Sceletal traction in femur (a) and shin (b) fractures

Complications of Complications of fractures.fractures.The early complications of fractures:The early complications of fractures:

Local.Local. Sequelae of immediate local complications: Sequelae of immediate local complications: skin necrosis and gangrene, Volkmann’s skin necrosis and gangrene, Volkmann’s ischaemia, gas gangrene, venous thrombosis, ischaemia, gas gangrene, venous thrombosis, visceral complications, joint infection, bone visceral complications, joint infection, bone infection, avascular necrosis, fracture blisters.infection, avascular necrosis, fracture blisters.

Remote.Remote. Fat embolism, pulmonary embolism, Fat embolism, pulmonary embolism, pneumonia, tetanus, delirium tremens.pneumonia, tetanus, delirium tremens.

The late complications of fractures:The late complications of fractures:Local.Local. Joint stiffness, secondary osteoarthritis, Joint stiffness, secondary osteoarthritis,

bone malunion, growth disturbance, chronic bone malunion, growth disturbance, chronic infection, difuse osteoporosis, Sudeck’s infection, difuse osteoporosis, Sudeck’s atrophy, refracture, muscle myositis ossificans, atrophy, refracture, muscle myositis ossificans, late tendon rupture, tissue atrophy, tendonitis.late tendon rupture, tissue atrophy, tendonitis.

Remote. Remote. Renal calculi, accident neurosis.Renal calculi, accident neurosis.

DislocationDislocationDislocationDislocation is a steady abnormal displacement of is a steady abnormal displacement of

articulate surfaces, with respect of one to another. articulate surfaces, with respect of one to another. If the articulate surfaces are stop adjoin, the If the articulate surfaces are stop adjoin, the dislocations are named total, by partial contiguity -dislocations are named total, by partial contiguity -incomplete or subdislocation. Tell dislocation is incomplete or subdislocation. Tell dislocation is usually accompanied by rupture of articulate usually accompanied by rupture of articulate surface capsule and going out of one articulate surface capsule and going out of one articulate surface through this rupture. Depending on the surface through this rupture. Depending on the damage of joint we tell about the dislocation of a damage of joint we tell about the dislocation of a humeral joint etc.humeral joint etc.

There are distinguished the inborn dislocations, which There are distinguished the inborn dislocations, which arise at the time of intrauterine life of a fetus, and arise at the time of intrauterine life of a fetus, and acquired, which are developed as a result of trauma acquired, which are developed as a result of trauma or pathological process in a region of a joint.or pathological process in a region of a joint.

Clinical picture. The questioning of a Clinical picture. The questioning of a victim is allowed to elucidate the victim is allowed to elucidate the circumstances of a trauma, mechanism of circumstances of a trauma, mechanism of damage. Pain in a joint and impossibility of damage. Pain in a joint and impossibility of movement in it are become stronger by movement in it are become stronger by motion.motion.

Numbness of extremity is by squeeze of Numbness of extremity is by squeeze of a nerve. Deformation in a joint is present.a nerve. Deformation in a joint is present.

X-ray photograph is confirming the X-ray photograph is confirming the diagnosis of a dislocation.diagnosis of a dislocation.

TreatmentTreatment Urgent qualified aid. First aid - transport splint or fixing Urgent qualified aid. First aid - transport splint or fixing

bandage, anodynes. Immediate transportation in a hospitalis bandage, anodynes. Immediate transportation in a hospitalis needed. Setting is carried out easier and results are better, if needed. Setting is carried out easier and results are better, if it is realized at first hours after trauma. Dislocations of 2-5 it is realized at first hours after trauma. Dislocations of 2-5 days are set difficulty, and 3-4 weeks later are often required days are set difficulty, and 3-4 weeks later are often required the operation.the operation.

The setting of dislocations must be carried out under the The setting of dislocations must be carried out under the anaesthetization without fail. The complete relaxation of anaesthetization without fail. The complete relaxation of muscles is necessary for quick setting of dislocation that is muscles is necessary for quick setting of dislocation that is achieved by total anaesthetization. Use of rough, physical achieved by total anaesthetization. Use of rough, physical force lead to the complementary damages of capsule of a force lead to the complementary damages of capsule of a joint and development of recidivations of dislocation joint and development of recidivations of dislocation (habitual dislocation), which are more often met in a (habitual dislocation), which are more often met in a shoulder and maxillotemporal joint.shoulder and maxillotemporal joint.

There are some methods used of setting of a dislocation There are some methods used of setting of a dislocation for the restoration of normal anatomical correlations in a for the restoration of normal anatomical correlations in a joint, which are based on the relaxation of muscles of joint, which are based on the relaxation of muscles of articulate region, and setting of dislocated articulate surface. articulate region, and setting of dislocated articulate surface. With use of a number of motions, which are typical for every With use of a number of motions, which are typical for every joint. Tills movements in a damaged joint as though repeat joint. Tills movements in a damaged joint as though repeat the motions in reserve succession, which provoked the the motions in reserve succession, which provoked the dislocationdislocation

Kocher's method - consist of 4th stages a. crooking in the elbow joint with a putting of shoulder to the trunk.b. Traction downwards and simultaneously rotation of a shoulder. c-d stages - raising of arm upwards and simultaneously rotation of a shoulder with the following throw of hand on the healthy upershoulder. Control X-ray photograph is made at once after setting. Extremity is fixed on 6-10 days in a functionally advantageous posture by bandage or stretching and then the LFC complex is carried out.