The First Affiliated Hospital Of Zhengzhou University
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The First Affiliated Hospital of ZhengZhou University Orthopaedics Wang Jue
Joint dislocation
Character of joint dislocation malformation elasticity fixation joint emptiness
Classification:
According to direction of dislocation: according to distal bone direction we can classify dislocation as forward or posterior. For example: this patient is forward dislocation.
According to time and times: Over 2 weeks is called dated dislocation. less than 2 weeks is called fresh dislocation. According to articular capsule whether open to outside classifies as open and close dislocation. According to degree of dislocation classifies as half or all dislocation.
1. 2.
3.
Treatment principle Reduce as early as possible. Fixation should be reversed direction according to dislocation after reduction. (understanding that is very important) Function exercise forepart.
Symbol of reductive success
non-general activity
osteo-symbol recover
x-ray shows recovered
Shoulder joint dislocation
shoulder joint dislocation
anatomy
shoulder joint dislocation
Classification (according to coracoid)
Forward dislocation
posterior
Upright under glenoid Upright above glenoid
Under coracoid Under glenoid Under clavicle
Under acromion Under glenoid Under ridge
肩关节脱位：示意 图 All belong to anterior dislocation.
under glenoid
under coracoid
under clavicular
clinic and dignosis
trauma history
indirection
direction
pain, swell, malfunction healthy hand holds suffered hand up square shoulder malfunction Dugas symptom x-ray
Dugas symptom
shoulder dislocation x-ray
Forward dislocation mechanism (magral): after fall, palm touches floor, upper-limb is lateral abduction and lateral rotation, body inclines and touched floor. All lead forward articular capsule trauma and lead shoulder joint forward dislocation.
Treatment Local or general anesthesia should be attempted first
REDUCTION Hippocrates way Traction , foot tips shoulder joint, medial adduction, medial rotation.
FIXATION
Fixing upper limb is at medial adduction and medial rotation. After 3 weeks function exercises.
Subluxation of head of radius Trauma mechanism 2~3 old children is often found. There are history about inferior arm pulled suddenly. Diagnosis: elbow is at half-flexion, inferior arm is at pronation, location pain.
Reduction Thumb presses head of radius and turn inferior arm anterior or posterior by turns, at the same time, flex elbow joint.
Fixation after reduction, the elbow joint need not be fixed, only telling paterfamilias does not pull child inferior arm in 2 weeks.
Dislocation of elbow
Classification According to ulna dislocation direction, dislocations of elbow have been variously described as anterior, posterior, medial and lateral. posterior dislocation is familiar.
Posterior dislocation mechanism patient falls, elbow joint is extensive position, inferior arm is supnation position and palm touches floor. Force transfers and make elbow joint over-extension and tears anterior atricular capsule, at last, elbow joint dislocate.
Ruduction After local anaesthesia, first put inferior arm at supnation position, second inferior arm is in traction, third two thumb push olecranon along inferior arm
Symbol of reductive success elbow joint works well, and elbow posterior triangle is recovered.
Fixation Elbow joint flex 90°, all arm is fixed 2~3 weeks in plaster fixation.
Hip dislocation Dislocation or fracture-dislocation of the hip is an orthopaedic emergency and must be reduced immediately. The longer the hip remains dislocated, the more likely is the possibility of complications, including avascular necrosis of the femoral head and posttraumatic arthritis.
Hip dislocation Anato my
Classification Dislocations of the hip have been described as anterior, posterior, and central. Central dislocations are associated with fractures of the acetabulum
Posterior dislocations of the hip
Dislocation mechanism
pathogeny Indirection force
Hip joint flexion and adduction
Femoral head top-outskirt surpass acetabulum beside Posterior dislocation
Posterior dislocation of hip
Clinic behave and diagnosis coxa pain 、 coxae malfunction 、 limb shorted coxa flexion 、 adduction 、 inner spire malformation elasticity fixation 、 hip can touch femoral head 、 greater trochanter go up a few has ischium nerve injury symptom for example: lower limb pain motor and sensory nerve deficit x-ray can define dislocation complexion and whether fracture
Posterior dislocation
treatment Reduction （ Allis ） Fixation (traction 2~3weeks) Function exercise Complex posterior with arthrosis fructure should open reduced as early as possible
Anterior dislocation the femoral head passes through the joint capsule and lies anterior the acetabulum
Dignosis •With strong trauma history • limb with outspire ， abduction ， flexion malformations • groin with swell ， can touch femoral head ， and the femoral vessels and nerve may be injured • x-ray can get diagnosis
Anterior dislocation
treatment Reduction Allis •
Fixing
•
Function exercise
What is Central dislocation of hip? The term central fracture-dislocation of the hip has been used to describe any acetabular fracture with medial subluxation of the femoral head
CENTRAL DISCOLATION
Dignosis Acetabular fractures generally are caused by high-energy trauma, and associated injuries are frequent Haemorrhage cause shock Local swell 、 pain 、 malfunction thigh upside with haematoma sometimes with abdomen bowels injure X-ray can get diagnosis ， CT three-dimension can find out acetabulum fracture circs
treatment first should treat haemorrhage or bowels trauma bone-tow forepart ， and let femoral reduction if reduction isnot very well ， open interior fixation acetabulum get severe trauma ， joint fuse and joint replace is availble
Traction reduction
OUTCOME AND COMPLICATIONS
mortality rates after acetabular fractures range from 0 to 2.5% posttraumatic arthritis Avascular necrosis causes femoral head necrosis Infections Sciatic nerve palsies Heterotopic ossification
Joint dislocation
Character of joint dislocation malformation elasticity fixation joint emptiness
Classification:
According to direction of dislocation: according to distal bone direction we can classify dislocation as forward or posterior. For example: this patient is forward dislocation.
According to time and times: Over 2 weeks is called dated dislocation. less than 2 weeks is called fresh dislocation. According to articular capsule whether open to outside classifies as open and close dislocation. According to degree of dislocation classifies as half or all dislocation.
1. 2.
3.
Treatment principle Reduce as early as possible. Fixation should be reversed direction according to dislocation after reduction. (understanding that is very important) Function exercise forepart.
Symbol of reductive success
non-general activity
osteo-symbol recover
x-ray shows recovered
Shoulder joint dislocation
shoulder joint dislocation
anatomy
shoulder joint dislocation
Classification (according to coracoid)
Forward dislocation
posterior
Upright under glenoid Upright above glenoid
Under coracoid Under glenoid Under clavicle
Under acromion Under glenoid Under ridge
肩关节脱位：示意 图 All belong to anterior dislocation.
under glenoid
under coracoid
under clavicular
clinic and dignosis
trauma history
indirection
direction
pain, swell, malfunction healthy hand holds suffered hand up square shoulder malfunction Dugas symptom x-ray
Dugas symptom
shoulder dislocation x-ray
Forward dislocation mechanism (magral): after fall, palm touches floor, upper-limb is lateral abduction and lateral rotation, body inclines and touched floor. All lead forward articular capsule trauma and lead shoulder joint forward dislocation.
Treatment Local or general anesthesia should be attempted first
REDUCTION Hippocrates way Traction , foot tips shoulder joint, medial adduction, medial rotation.
FIXATION
Fixing upper limb is at medial adduction and medial rotation. After 3 weeks function exercises.
Subluxation of head of radius Trauma mechanism 2~3 old children is often found. There are history about inferior arm pulled suddenly. Diagnosis: elbow is at half-flexion, inferior arm is at pronation, location pain.
Reduction Thumb presses head of radius and turn inferior arm anterior or posterior by turns, at the same time, flex elbow joint.
Fixation after reduction, the elbow joint need not be fixed, only telling paterfamilias does not pull child inferior arm in 2 weeks.
Dislocation of elbow
Classification According to ulna dislocation direction, dislocations of elbow have been variously described as anterior, posterior, medial and lateral. posterior dislocation is familiar.
Posterior dislocation mechanism patient falls, elbow joint is extensive position, inferior arm is supnation position and palm touches floor. Force transfers and make elbow joint over-extension and tears anterior atricular capsule, at last, elbow joint dislocate.
Ruduction After local anaesthesia, first put inferior arm at supnation position, second inferior arm is in traction, third two thumb push olecranon along inferior arm
Symbol of reductive success elbow joint works well, and elbow posterior triangle is recovered.
Fixation Elbow joint flex 90°, all arm is fixed 2~3 weeks in plaster fixation.
Hip dislocation Dislocation or fracture-dislocation of the hip is an orthopaedic emergency and must be reduced immediately. The longer the hip remains dislocated, the more likely is the possibility of complications, including avascular necrosis of the femoral head and posttraumatic arthritis.
Hip dislocation Anato my
Classification Dislocations of the hip have been described as anterior, posterior, and central. Central dislocations are associated with fractures of the acetabulum
Posterior dislocations of the hip
Dislocation mechanism
pathogeny Indirection force
Hip joint flexion and adduction
Femoral head top-outskirt surpass acetabulum beside Posterior dislocation
Posterior dislocation of hip
Clinic behave and diagnosis coxa pain 、 coxae malfunction 、 limb shorted coxa flexion 、 adduction 、 inner spire malformation elasticity fixation 、 hip can touch femoral head 、 greater trochanter go up a few has ischium nerve injury symptom for example: lower limb pain motor and sensory nerve deficit x-ray can define dislocation complexion and whether fracture
Posterior dislocation
treatment Reduction （ Allis ） Fixation (traction 2~3weeks) Function exercise Complex posterior with arthrosis fructure should open reduced as early as possible
Anterior dislocation the femoral head passes through the joint capsule and lies anterior the acetabulum
Dignosis •With strong trauma history • limb with outspire ， abduction ， flexion malformations • groin with swell ， can touch femoral head ， and the femoral vessels and nerve may be injured • x-ray can get diagnosis
Anterior dislocation
treatment Reduction Allis •
Fixing
•
Function exercise
What is Central dislocation of hip? The term central fracture-dislocation of the hip has been used to describe any acetabular fracture with medial subluxation of the femoral head
CENTRAL DISCOLATION
Dignosis Acetabular fractures generally are caused by high-energy trauma, and associated injuries are frequent Haemorrhage cause shock Local swell 、 pain 、 malfunction thigh upside with haematoma sometimes with abdomen bowels injure X-ray can get diagnosis ， CT three-dimension can find out acetabulum fracture circs
treatment first should treat haemorrhage or bowels trauma bone-tow forepart ， and let femoral reduction if reduction isnot very well ， open interior fixation acetabulum get severe trauma ， joint fuse and joint replace is availble
Traction reduction
OUTCOME AND COMPLICATIONS
mortality rates after acetabular fractures range from 0 to 2.5% posttraumatic arthritis Avascular necrosis causes femoral head necrosis Infections Sciatic nerve palsies Heterotopic ossification
