外科学课件：Dislocation of the Joints

1、Dislocation of the Joints,Definition,Joint Dislocation,Joint Subluxation,Joint Sprain,refers to damage or tearing of ligaments or a joint capsule,Muscle strain,Classification,Traumatic dislocation,excessive force is applied to a joint,Pathological dislocation,Fresh dislocation Old dislocation Habitu

2、al or Recurrent Dislocation,Congenital dislocation,Treatment,Reduction,Immobilization,Rehabilitation,Traction-counter-traction technique,Specific maneuvers,Dislocation of the Shoulder Joint,Anatomy,Deltoid m.,Anterior (forward) : Over 95% Sub-glenoid Sub-coracoid Subclavicular Intrathoracic or retro

3、peritoneal : very rare,Types,Superior dislocation(Upward ),Posterior (backward) Posterior dislocations are occasionally due to electrocution or seizure and may be caused by strength imbalance of the rotator cuff muscles. Posterior dislocations often go unnoticed, especially in an elderly patient,Inf

4、erior (downward) Inferior dislocation is the least likely form, occurring in less than 1% of all shoulder dislocation cases. This condition is also called luxatio erecta because the arm appears to be permanently held upward or behind the head It is caused by a hyper abduction of the arm that forces

5、the humeral head against the acromion. Inferior dislocations have a high complication rate as many vascular, neurological, tendon, and ligament injuries are likely to occur from this kind of dislocation.,Diagnosis,Special appearance,Square shoulder,Dugas sign,X ray,MRI,Bankart lesion - Fracture disl

6、ocation: - fracture of humeral head, neck, or greater tuberosity; - associated greater tuberosity frx may actually have less frequent recurrent instability than dislocations that occur w/o frx; - compression or avulsion of anterior glenoid (see west point view) -GLAD lesion Hill Sachs lesion: SLAP l

7、esions Rotator cuff tear - Neurologic injuries,Associated Injuries:,Treatment,Reduction,Hippocrates Maneuver Stimson Maneuver Kocher Maneuver,(460-377 BC),Immobilization Rehabilitation,X-ray check , CT, or MR,Dislocation of the Elbow,Three points forming isosceles triangle on flexed elbow,Posterior

8、elbow triangle,Classification of the elbow dislocation,posterior, posterolateral, posteromedial, lateral, medial elbow dislocations without fracture are termed simple. whereas dislocations with frx are termed complex; - dislocation w/ radial head frx: most common complex dislocation;,Pathoanatomy: -

9、 rupture of capsule, rupture of MCL, lateral ligaments, rupture of flexor pronator mass and less commonly, injury to brachialis muscle; - lateral collateral ligament may be the essential lesion in recurrent or persistent instability following simple dislocations of the elbow - rupture of brachial ar

10、tery has been reported,Diagnosis,Semiflexion elastic fixation of the elbow,X ray,deformity,Treatment,Non-operative,Operative,Complications,Valgus instability Posterolateral instability Heterotopic ossification Chronic dislocation,Nursemaid Elbow or Pulled Elbow,Subluxation of the Radial Head,Disloca

11、tion of the Hip,- anterior dislocation - central acetabular fracture dislocations - posterior hip dislocations,Types of dislocation,Anatomic features,The unstable position,Dashboard Injuriesposterior dislocation,MECHANISMS OF INJURY,A, this patient sustained an anterior dislocation of hip, the lower

12、 extremity abducted, B, passengers in the back seat of car -posterior dislocation. Wearing a seabelt may have prevent the forward thrust of the knee against the front seat of the car.,The anterior dislocation of hip,With wide abduction, impact of knee against dashboard (both) hip.,Diagnosis of Poste

13、rior Frx and dislocation of the hip,limb is shortened, internally rotated, and adducted,Thompson and Epstein Classification: Type I: w/ or w/o a minor fracture Type II: w/ large single frx of post. acetabular rim; Type III: w/ comminution of rim of acetubulum w/ or w/o major frag; Type IV: w/ a frac

14、ture of the acetabular floor Type V: w/ a fracture of the femoral head,Closed Reduction of Posterior Hip Dislocation performed as soon a possible ( 8-12 hrs) - either in OR under GEA (optimal) or in ER w/ sedation if delays are expected - reduction may be performed w/ flouro, but the orthopaedist ma

15、y find that flouro interferes w/ hip flexion, which frequently is essential to performing an atraumatic reduction - frequently all that is needed is one assistant to apply pressure to the ASIS, as the surgeon flexes the hip while applying traction - reduction is felt as gentle clunk, at which point

16、x-rays are obtained,Treatment,Close Reduction Maneuvers of the Hip Posterior Dislocation,Rochester method Allis Maneuver Stimson Maneuver Bigelow Maneuver,Stimson maneuver,Close Reduction Maneuvers of the Hip Anterior Dislocation,Note the wide abduction and external rotation Pull in line of deformity,Complications of hip dislocation,Avascular necrosis Traumatic arthritis myositis ossificans. -H