What are Treatments for Dislocated Joints?

There are two types of bone and joint dislocations: traumatic dislocation and habitual dislocation. Bone and joint dislocations are divided into anterior dislocation and posterior dislocation according to the dislocation direction. Among them, previous dislocation is common, accounting for about 95%. Some patients have a tendency to have recurrent dislocations, called habitual dislocations. The dislocation of each joint has a certain dislocation direction due to the anatomical characteristics of different joints and the nature and direction of trauma.

Chinese name: Dislocation of bone and joint

Department: orthopedics

Bone and joint dislocation

A joint refers to a bone joint. A normal joint includes at least two bone ends, and the joint surfaces of adjacent two bones are in a convex and concave mating relationship. Joints can produce movements, such as flexion, extension, contraction, and extension. Dislocation of the joint means that the articular surface of the bone loses its normal involuntary relationship or part of the normal involuntary relationship.

Bone and joint dislocation classification

Joint dislocations are divided into 4 types according to the causes of dislocations:

1 traumatic dislocation violent joint dislocation caused by normal joints

2 Congenital dislocations Dislocation of the embryo or joint dislocation caused by external factors in the mother

3 pathological dislocation joint structure damage caused joint dislocation

4 habitual dislocation During traumatic dislocation, the joint capsule and ligaments are abraded at the bone attachment site, and there are unstable factors in the joint, which can be repeatedly caused by slight external force.

Joint dislocation is divided into 2 types according to the dislocation time:

1 Fresh dislocation : dislocation time is less than 3 weeks.

2 Old dislocation : dislocation time is more than 3 weeks, closed reduction is difficult, and often requires open reduction.

Joint dislocation is divided into 2 types according to whether the joint cavity is in communication with the outside world after dislocation:

1 closed dislocation: the skin is intact, the dislocation is not connected with the outside world.

2 open dislocation: the articular surface communicates with the outside world.

Bone joint dislocation physiology and pathology

1 Joint Dislocation-Pathophysiology

2 Displacement of the bone ends constituting the joint

3 Joint capsule tear, ligament, tendon damage

4 concurrent vascular and nerve damage

5 concurrent fractures

6 blood accumulation around the joint cavity, fibrous adhesions formed after hematoma mechanization

Bone and joint dislocation symptoms

1 joint dislocation-clinical manifestations

2 joint pain

3 local tenderness

4 joint dysfunction

5 bruises

6 swelling

Bone and joint dislocation treatment

Manual reset

After dislocation, it should be reset as soon as possible, and appropriate anesthesia (brachial plexus anesthesia or general anesthesia) should be selected to relax the muscles and make the reduction painless. Habitual dislocations do not require anesthesia. The resetting method should be gentle, and crude methods should be disabled to avoid additional injuries such as fractures or nerve damage.

After the reduction, the shoulder was restored to the normal shape of the blunt garden. The dislocated humeral head could no longer be touched under the axilla, subcoracoid process, or subclavian bone. The shoulder test became negative. X-ray examination of the humeral head was normal. If combined with avulsion fractures of the humerus tuberosus, the fractures and humeral shaft are often connected by periosteum. In most cases, the avulsion of the large tuberosity bone fragments after shoulder dislocation is also reduced.

Post-reduction treatment: After the anterior dislocation of the shoulder joint is reset, the affected limb should be kept in the adduction and internal rotation position, cotton pads should be placed on the armpit, and then fixed on the chest with a triangle towel, bandage or plaster. Rotate activities, but to prevent excessive abduction and external rotation to prevent dislocation. After the posterior dislocation is reset, it is fixed in the opposite position (ie abduction, external rotation and posterior extension).

2. Treatment of habitual anterior dislocation

The habitual dislocation of the shoulder joint is more common in young adults. The reason is generally believed that the injury was caused after the first dislocation of the trauma. Although it was reset, it was not properly and effectively fixed and rested. Due to the tearing or avulsion of the articular capsule and the damage to the cartilage labrum and labrum, the depression of the posterolateral humeral head has become equal to the pathological changes and the joints become loose.

For habitual dislocation of the shoulder, if dislocation is frequent, surgery should be used. The purpose is to strengthen the anterior wall of the joint capsule, prevent excessive external rotation and abduction, and stabilize the joint to avoid re-dislocation.

3. Surgical reduction for joint dislocation

There are a few shoulder dislocations that require surgical reduction. The indications are: anterior dislocation of the shoulder joint with biceps brachii longus tendon slippage hindering manual reduction; large humeral tuberosity avulsion fracture, and the fracture piece stuck to the humeral head and joint Those who affected the reduction between the glenoids; those with surgical neck fractures of the humerus who could not be rehabilitated; those with coracoid processes, acromion, or glenoid fractures with significant displacement; those with large axillary injury.

Bone and joint dislocation general care

Measure one: assist the doctor to reset as soon as possible

Measure two: Maintain effective fixation: time is 2-3 weeks, and the time of old dislocation and combined fracture should be appropriately extended.

Measure three: Pain care: early reduction and fixation, support for the affected limb, medication, cold and hot compress, suggestion, etc.

Measure four, observation and nursing of complications.

Step five: maintain the integrity of the skin

Measure 6. Functional exercise

Measure 7. Prevent the education of habitual dislocation related knowledge.

Dislocation of shoulder and joint

Dislocation of the shoulder joint is a common manifestation of joint dislocation. The shoulder is an important bearing part of human activity and it is very easy to cause patients. The shoulder joint is composed of the glenoid and humeral head of the scapula. The shallow glenoid humeral head is large, the joint capsule and ligaments are weak and loose, and the range of joint movement is large.

Causes of shoulder dislocation:

1 indirect violence

2Direct violence

Pathology of shoulder dislocation:

1 When the fall caused by indirect violence, the palms are supported, the shoulder joints are abducted and rotated, and the humeral head breaks through the anterior wall of the joint capsule, slipping out of the scapula and dislocation.

2 Direct violence can cause a direct injury to the back of the shoulder joint, causing the humeral head to dislocate forward and downward.

Clinical manifestations of dislocation of the shoulder: square shoulder deformity, glenoid emptiness, protruding shoulder, and shoulder test (positive). Merge brachial plexus injury.

Dislocation of bone and elbow

Causes and classification of elbow dislocation

Indirect violencefallelbow extensionthe violence spread to the upper end of the ulna and the olecranon process, and the proximal end of the ulnar radius was dislocated to the rear of the distal humerusthe humerus condyle prolapsed forwardthe elbow joint was dislocated. (Most common)

Direct violencethe elbow was hit from behinda fracture in the ulna and a front dislocation of the elbow.

Clinical manifestations of dislocation of elbow joint

The elbows have become thicker, the upper limbs have become shorter, and the rear of the hawk is prominent. The elbow joint is elastically fixed in a semi-extended position, approximately 45 °. The posterior elbow triangle loses its normal relationship. In the case of posterior dislocation, the median nerve or ulnar nerve can be combined.

Elbow function training method

1 During the fixed period, extend and master the fist, finger flexion and extension, and perform shoulder and wrist joint activities under the protection of external fixation.

2 After the external fixation is removed, practice elbow extension and flexion, forearm rotation, and muscle strength around the elbow.

Dislocation of bone and joint

The hip joint is composed of the femoral head and the acetabulum. The acetabulum is deep and large, and can accommodate most of the femoral head. It is surrounded by strong ligaments and muscle protection, and the structure is stable.

Hip dislocation refers to the violent impact from the knee to the hip during flexion or flexion of the hip joint, and the femoral head penetrates the posterior joint capsule; when bending, the heavy object hits the lumbosacral region, causing the femoral head to break through the joint capsule backwards. .

Clinical manifestations of hip dislocation:

Clinical manifestations of hip dislocation 1 Hip pain and joint dysfunction are obvious. The swelling is not noticeable.

Clinical manifestations of dislocation of the hip joint 2 The lower limb of the affected side showed flexion, adduction, internal rotation and shortened deformity.

Clinical manifestations of hip dislocation 3 The hip can touch the prolapsed femoral head, and the tuberosity moves upward.

The clinical manifestations of hip dislocation 4 can be associated with sciatic nerve injury.

Hip joint exercise method

l Rest in bed for 4 weeks, perform quadriceps contraction exercise and ankle movement, start hip joint exercise after 3 weeks, remove skin traction, use double crutches, and start weight bearing if the blood supply of femoral head is normal after 3 months.

Bone joint dislocation

Comparison table of joint dislocations

Comparison table of joint dislocations

Dislocations of bones and joints that are easily confused

1 Distinction between total condylar dissection of the distal humerus and dislocation of the elbow joint:

The humeral miniskullization center on the children's X-ray film is not visible, and only the X-ray film diagnosis can easily misdiagnose the dislocation of the elbow joint. Since the strength of the palatal plate in childhood is far less than that of the joint capsule and ligaments, the damage to children's joints must first consider the possibility of epiphyseal injury. Second, careful and comprehensive clinical examination is also very important. According to the location of the swelling, tenderness and ecchymosis, a preliminary impression of the fracture site can be made, and some special bony landmarks such as the posterior elbow triangle are used to diagnose and distinguish the original epiphyseal separation of the lower humerus and dislocation of the elbow joint. Third, familiar with the anatomy and physiological evolution of the elbow joint in children can improve the diagnostic compliance rate when reading X-rays, so as to avoid misdiagnosis and mistreatment and cause serious consequences for the growth and development of children.

2 Identification of anterior dislocation of elbow joint with ulna olecranon fracture and straight Mens fracture:

The main clinical feature of anterior elbow dislocation with ulna olecranon fracture is fracture of the proximal ulna, and the distal humerus passes through the ulna olecranon, causing anterior dislocation of the elbow joint. Because most of them are caused by high-energy trauma, most of the proximal ulna are complicated comminuted fractures. A few can also occur in simple oblique fractures of the olecranon. Most of the humerus and radial joints are accompanied by dislocation, but the upper radius and ulnar joints are not separated. The main points of diagnosis are:

(1) anterior dislocation of the elbow joint; (2) fracture of the proximal ulna; (3) no separation of the superior radial ulnar joint.

3 supracondylar fracture of the humerus and dislocation of the elbow:

(1) For supracondylar fracture of the humerus (Shen straight type), the elbow joint can be partially moved, the posterior elbow triangle is unchanged, the upper arm is shortened, and the forearm is normal.

(2) When the elbow joint is dislocated, the elbow joint is elastically fixed, the posterior elbow triangle changes, the upper arm is normal, and the forearm is shortened.