Dislocation – the full shift of the articulate ends of bones relatively each other. Articulate surfaces stop being congruent, the movements in a joint become impossible. Dislocation can be followed by injury of bones and soft fabrics. Ruptures of the articulate capsule, muscles and sheaves, injuries of nerves and vessels, and also inside - and extra articulate changes are possible. The trauma, various pathological processes and violations of development can become the reason of dislocation. Pains and gross violation of a configuration of a joint are observed. The active movements become impossible, in attempt of passive movements the springing resistance is defined. The diagnosis is exposed on the basis of survey and data of a X-ray analysis. If necessary it is appointed KT or MPT. Treatment – reposition of dislocation (closed is more often). At chronic dislocations operation is necessary. After reposition the immobilization and functional treatment (physical therapy, LFK, massage) is appointed. The forecast is usually favorable.
Dislocation – a pathological state at which articulate surfaces are displaced relatively each other. A part of an extremity is considered dislocated disteel (remote from a trunk). An exception – clavicle dislocation (the dislocated end of a bone is specified in the name) and vertebra dislocation (the overlying vertebra is specified). Dislocation is pathology, rather widespread in traumatology. Traumatic dislocations make 1,5-3% of total number of damages of the musculoskeletal device. Traumatologists are engaged in treatment of dislocations, is more rare – orthopedists.
The joint is a mobile connection of two or more bones covered with a sinovialny cover, divided by an articulate crack and connected among themselves by the capsule and sheaves. There are several types of joints (ellipsoidal, blokovidny, spherical, saddle), but, regardless of a form, all of them are formed congruent (coinciding in a form, supplementing each other) by surfaces. Thanks to such structure, at the movements articulate surfaces slide from each other, and the joint works as the hinge. The movement happens at the expense of the muscles which are attached to bones above and below a joint. The tight muscle pulls a bone in a certain direction, and the capsule and sheaves hold the articulate ends from excessive shift. At dislocation there is a mutual shift of the ends of the bones forming a joint. Surfaces cease "to coincide", the movements become impossible.
Simply it is possible to allocate three main mechanisms of formation of dislocation. Traumatic – as a result of the increased draft of muscles, direct stroke or violent influence at an indirect trauma the articulate ends of bones are excessively displaced. Influence is too strong, the capsule does not maintain and is torn, also the rupture of sheaves is possible. Pathological – because of various pathological processes durability of the capsule and sheaves decreases, they lose ability to hold the articulate ends of bones in the correct situation even at insignificant influences therefore dislocation can occur at the usual not forced movements. Congenital – because of anomalies of development of structures of a joint (bones, ligaments, the capsule) articulate surfaces initially do not coincide or do not keep in the correct situation.
Taking into account degree of shift allocate complete dislocations at which the articulate ends completely disperse, and incomplete dislocations at which partial contact of articulate surfaces remains.
Taking into account an origin distinguish:
- Congenital dislocations – arisen owing to malformations of elements of a joint. Most often congenital dislocation of a coxofemoral joint meets, congenital dislocations of a knee joint and patella are less often observed.
- The acquired dislocations – arisen owing to a trauma or a disease. Traumatic dislocations are the most widespread. The top extremities suffer 7-8 times more often than lower.
Traumatic dislocations are in turn subdivided:
- Taking into account prescription of damage: fresh (up to 3 days from the moment of a trauma), stale (up to 2 weeks from the moment of a trauma), old (more than 2-3 weeks from the moment of a trauma).
- With violation or without violation of integrity of integuments and subjects of soft fabrics: opened and closed.
- Taking into account existence or lack of complications: uncomplicated and complicated – followed by injury of nerves or vessels, and also near - and intra articulate changes.
Also allocate not reducible dislocations – in this group dislocations treat with the interposition of soft fabrics interfering the closed reposition and all chronic dislocations.
Besides, distinguish two separate groups of pathological dislocations:
- Paralytic dislocation – the reason of development becomes paralysis of one group of muscles because of which draft of muscles antagonists prevails.
- Habitual dislocation – the repeating dislocation which arises owing to weakness of the capsule, muscles and sheaves and/or change of a configuration of articulate surfaces. The premature beginning of movements in a joint after reposition of sharp traumatic dislocation becomes the development reason most often. Less often habitual dislocation arises at the diseases affecting bones and sheaves (arthroses, osteomyelitis, poliomyelitis and some system diseases, including hereditary character).
Indirect influence becomes the reason of traumatic dislocation usually: blow or falling on the next joint or a disteel part of an extremity (so, dislocation of a shoulder joint can arise when falling on an elbow or a forearm), the forced reduction of muscles, violent bending and extension of a joint, twisting, draft for an extremity. Less often damages arise owing to a direct trauma (blow in a joint or falling on it). At blows and usual falling the isolated dislocation, as a rule, develops (more rare – perelomovyvy). At road incidents, falling from height and production injuries the dislocation combination to other damages of bone and muscular system (basin changes, spinal fractures and extremities), can be observed by a craniocereberal injury, a stupid injury of a stomach, injury of a thorax and injuries of urinogenital system.
Sharp traumatic dislocations are followed by intensive pain. At the time of a trauma the characteristic click or cotton is usually heard. The joint is deformed, swells, on skin in the struck area bruises can develop. The active and passive movements are absent, in attempt of passive movements the springing resistance comes to light. The pobledneniye and a cold snap of integuments is possible is lower than damage level. At damage or a sdavleniye of nervous trunks the patient complains of a sleep, a pricking and decrease in sensitivity.
The diagnosis of dislocation is exposed on the basis of a clinical picture and data of a radiological research. In certain cases (usually at the complicated dislocations) appoint joint MPT or KT. At suspicion on a sdavleniye or damage of vessels and nerves of the patient direct to consultation to the vascular surgeon and the neurosurgeon. Treatment is carried out in the conditions of emergency station or traumatologic office. Need for hospitalization is defined by localization of dislocation, absence or existence of complications.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
It is necessary to bring the patient with suspicion of traumatic dislocation as soon as possible in specialized medical institution (an optimal variant – within the first 2-3 hours) as in the subsequent the accruing hypostasis and reflex tension of muscles can complicate reposition. It is necessary to record an extremity, using the tire or a kosynochny bandage, to give to the patient anesthetic and to put cold to the field of damage. Patients with dislocations of the lower extremities are transported in a prone position, patients with dislocations of the top extremities – in a sitting position.
Uncomplicated dislocations are subject to the closed reposition. Fresh uncomplicated dislocations of small and average joints usually set under local anesthesia, dislocations of large joints and stale dislocations – under anesthetic. At children of younger age reposition in all cases is performed under the general anesthesia. At the opened, complicated and chronic dislocations open reposition is carried out. In the subsequent rest is appointed and the immobilized bandage is applied. The term of an immobilization is defined by features and localization of dislocation. Premature removal of a bandage and the early beginning of movements in a joint are not allowed at all as it can lead to development of habitual dislocation. In the rehabilitation period LFK, physical therapy and massage is appointed. The forecast is favorable.
First place on prevalence is won by traumatic dislocation of a shoulder, then dislocations of fingers and an elbow joint follow. Slightly less often dislocations of a patella and coxofemoral joint meet.
Traumatic dislocation of a shoulder
High frequency of pathology is caused by features of a structure of a joint (the head of a humeral bone adjoins to an articulate hollow on a small extent and, generally keeps at the expense of muscles, ligaments and special myagkotkany education – an articulate lip), considerable loadings and large volume of movements in a joint. At damage there is an acute pain, there is a feeling that the shoulder is not in the place. The shoulder joint looks unnaturally: the head of a humeral bone is not looked through, on its place the smoothed surface with the pointed upper edge is visible. The shoulder looks lowered. The hand of the patient is usually pressed to a body.
Depending on the direction of shift of a head allocate three types of dislocations of a shoulder joint: forward, back and lower. Forward dislocation – the most widespread (according to various data arises in 80-95% of cases). The head is displaced forward and it appears or under a beak-shaped shoot of a shovel (in this case there is subbeak-shaped dislocation), or under a clavicle (subclavial dislocation). Usually forward dislocations are followed by insignificant injury of an articulate lip (the cartilaginous roller which is continuation of an articulate hollow of a shovel and helps a head of a shoulder to keep with a joint). Back dislocation develops infrequently (less than 20-5% of cases) and is followed by considerable injury of an articulate lip. The lower dislocation arises very seldom. At such damage the head of a shoulder "goes" down, and the hand up to the moment of reposition is in the lifted situation.
For confirmation of the diagnosis carry out a X-ray analysis of a shoulder joint. KT of a shoulder joint and MRT of a shoulder joint usually are not required, an exception are suspicions on heavy damages of myagkotkanny structures and a perelomovyvikha. Insignificant violation of blood supply and a small sleep of an extremity are usually caused by a sdavleniye of neurovascular bunches and spontaneously disappear after reposition of dislocation. Gross violations of sensitivity can demonstrate injury of nerves and are the indication for consultation of the neurosurgeon.
Reposition of fresh dislocations is usually carried out in emergency station under local anesthesia. Stale dislocation and unsuccessful first attempt of reposition are the indication of reposition under the general anesthesia. Dzhanelidze's way is usually used, is more rare – Kokher's way. After reposition the hand is fixed for three weeks. During this period UVCh for reduction of the inflammatory phenomena and LFK (the movement of a brush and a luchezapyastny joint) is appointed. Then the immobilization is stopped, gradually add exercise for development of an elbow and shoulder joint to the LFK complex. It is necessary to remember that healing of the capsule of a joint requires time. Too early unauthorized removal of a bandage (even in the absence of pains) can lead to formation of habitual dislocation.
Habitual dislocation of a shoulder
Usually arises after undertreated sharp traumatic dislocation. The contributing factors are weakness of muscles, the raised capsule tensile properties, a slabovognuty articulate hollow of a shovel and a big spherical head of a shoulder. Habitual dislocation of a shoulder is followed by less intensive pain syndrome and can arise even at insignificant influences. Frequency of repeated dislocations strongly fluctuates – from 1-2 times a year to several times a month. Insolvency of the capsule of a joint is the reason of development. Surgical treatment is required. The indication to operation are 2-3 and more dislocations within a year.
Traumatic dislocations of phalanxes of fingers
Most often develop at blow in a finger-tip with application of force in the proximal direction. There is sharp pain and noticeable visible deformation of a finger in a joint. The movements are impossible. The accruing hypostasis is noted. For confirmation of the diagnosis carry out a brush X-ray analysis. Reposition is performed on an outpatient basis, under local anesthesia. Then apply a plaster bandage and appoint UVCh.
Traumatic dislocation of an elbow joint
Falling arm-distance or blow in the bent hand becomes the reason of a trauma. In the first case there is back dislocation, in the second – forward. Damage is followed by severe pain and considerable hypostasis of soft fabrics. In an elbow the expressed deformation comes to light, the movements are impossible. Pulse on a beam artery is weakened, the sleep is often observed. At back dislocations the head of a beam bone is probed in front, at lobbies – behind. Distinctive feature of dislocations of an elbow joint is the combination to fractures of an elbow and beam bone, and also injury of nerves and vessels. For confirmation of the diagnosis the X-ray analysis of an elbow joint is carried out. According to indications consultations of the neurosurgeon and the vascular surgeon are appointed. Treatment is performed in the conditions of a hospital. Tactics of treatment depends on features of damage. The closed repozition is in most cases made. At impossibility to set dislocation, to compare or hold bone otlomk (at perelomovyvikha) surgery is carried out.
Traumatic dislocation of a patella
The trauma arises owing to falling or blow in a knee at the time of reduction by the four-head of a muscle. More often side dislocations of a patella develop (the patella is displaced knutr or knaruzh). The torsion (the patella is developed around a vertical axis) are less often observed and horizontal (the patella is developed around a horizontal axis and takes root between the articulate surfaces of the bones forming a knee joint) dislocations. Damage is followed by sharp pain. There is a deformation, there is an accruing hypostasis. The knee is slightly bent, the movements are impossible. At a palpation the displaced patella is defined. It is quite often observed .
The diagnosis is exposed on the basis of characteristic symptomatology and data of a X-ray analysis of a knee joint. Reposition usually comes easy and is made under local anesthesia. Also spontaneous reposition is possible. At a gemartroza the joint puncture is carried out. After recovery of the natural anatomic provision of a patella on a leg impose to steak for 4-6 weeks. Appoint UVCh, massage and LFK.
Traumatic dislocation of a hip
Results from an indirect trauma, usually – at road incidents and falling from height. Depending on an arrangement of a head of a hip can be forward and back. Dislocation of a hip is shown by sharp pain, the hypostasis, deformation of the struck area compelled by position of an extremity and shortening of a hip. The movements are impossible. For specification of the diagnosis the X-ray analysis of a coxofemoral joint is carried out. Reposition is made under the general anesthesia in the conditions of a hospital. Then skeletal extension for 3-4 weeks is imposed, the physical therapy and LFK is appointed.
The most widespread – congenital dislocation of a hip. Results from an underdevelopment of a head of a hip and an articulate hollow. It is more often observed at girls. Comes to light right after the birth. At babies it is shown by restriction of assignment of an extremity, shortening of an extremity and asymmetry of skin folds. In the subsequent there is lameness, at bilateral dislocation – duck gait. The diagnosis is confirmed by a X-ray analysis, KT of a coxofemoral joint and MRT of a coxofemoral joint. Treatment begins from first months of life. Special plaster bandages and tires are used. At inefficiency of conservative treatment surgery before achievement of 5-year age is recommended.
The second place on prevalence is taken by congenital dislocation of a patella. In comparison with dislocation of a hip is rather rare anomaly. Can be isolated or be combined with other malformations of the lower extremities. It is more often observed at boys. It is shown by instability when walking, bystry fatigue and restriction of movements in a joint. The X-ray analysis of a knee joint testifies to an underdevelopment and shift of a patella. Dislocation is eliminated in the surgical way, moving own ligament of a patella.
If treatment is not carried out, in the joint which is in a condition of congenital dislocation the progressing pathological changes develop, there is heavy arthrosis which is followed by strengthening of deformation of an extremity, violation of a support, decrease or disability. Therefore all children with suspicion of such pathology have to be under observation of children's orthopedists and receive timely adequate treatment.">