医学精品课件：外科dislocation.ppt

1、DISLOCATION,liang Xi,General Introduction of Dislocation,Definition Articular surface is missed their normal anatomic location. The direction of dislocation is determined by the distal end of the joint.,Classification 1、classified according to the causes of dislocation. 1) Traumatic dislocation ：Vio

2、lence 2) Congenital dislocation：arthodysplasia 3) Pathologic dislocation：articular structure are destroied by disease. 4) Habitual dislocation：microtrauma can cause dislocation if there are bone defect, capsule tears, ligament injury of joint.,2、 Classified according to the Interval from the injury

3、to treatment fresh dislocation:2 weeks old dislocation： 2 weeks 3、 Classified according to the capsule opening to the outside closed dislocation ： open dislocation ： 4、 Classified according to the degree of dislocation. complete dislocation： incomplete dislocation/semiluxation：,Anatomic change and c

4、omplication 1、the change of normal anatomic location. 2、fractures: involve articular noninvove articular,3、articular capsule tears,4、ligament injury,5、the calcification of the surrounding soft tissue of the joint 6、the injury of vessels and nerves,Pathological change of traumatic dislocation 1、soft

5、tissue injury around joint 2、articular cartilage and articular surface bone injury. 3、adherence and stiffness result from organization of hematoma in joint cavity, and the joint will be dysfunction.,Clinical manifestation and diaglosis 1. the history of trauma 2. symptom 3. common signs 4. specific

6、signs： deformity elastic fixation cavity of joint vacuity 5. the injury of vessels and nerves 6.ray、CT,Treatment principal of treatment: 1) reduction as early as possible 2) fixation on the opposite direction of dislocation. 3) early functional training,1、conservative treatment ：closed reduction is

7、applied to fresh dislocation 1）anaesthesia 2）reduce the signs of reduction success： passive activity recover to normal the bony signs are normal confirmed by x-ray 3）immobilization goal ：soft tissue related to joint stable have enough time to recovery/heal immobility time：3weeks 4）functional exercis

8、e,.0,2, Operative treatment: open reduction and immobilization indication： 1）the failure of closed reduction 2）having the injury of vessels and nerves 3） having fractures involve articular stable and implicate the function of joint. 4）old dislocation 5）habitual dislocation,Shoulder Joint Dislocation

9、,Classification 1、Anterior dislocation： subcoracoid dislocation subglenoid dislocation subclavicular dislocation 2、Posterior dislocation： subacromial dislocation subglenoid dislocation subspinous dislocation 3、 Inferior dislocation 4、superior dislocation,Anterior Shoulder Joint Dislocation Traumatic

10、 dislocation,Nearly 50% of all dislocations Mechanism of injury indirect violence direct violence,Clinical manifestation and diaglosis 1.the history of trauma 2.symptom mon signs,4.specific signs：square shoulder deformity elastic fixation cavity of joint vacuity Dugas sign (+),5.ray、CT、MRI,6. the in

11、jury of vessels and nerves plication: the injury of vessels and nerves, the fractures of glenoid, greater tuberosity, coracoid process, the injury of rotator cuff tears,Treatment 1）anesthesia： brachial plexus block or joint local block,2）reduction Hippocratic technique the signs of reduction success

12、： passive activity recover to normal the bony signs are normal Dugas sign (-) confirmed by x-ray,Operation 1. Bankart lesion repair,2. fracture,3) immobilization goal ：soft tissue related to joint stable have enough time to recovery/heal immobility time：3weeks 4） functional exercise,Elbow dislocatio

13、n,Trochlea of humerus,Olecranon,coronoid process,semilunar notch,classification： posterior dislocation medial dislocation lateral dislocation medial dislocation anterior dislocation burst dislocation crack,Mechanism of posterior dislocation fall with elbow extend and forearm supination hand touch on

14、 the ground violence transmit to the elbow and make the elbow hyperextension olecranon contact on the olecranon fossa and became a pivot point of lever, then it level the semilunar notch out from trochlea troclea move to the front of coronoid process and olecranon move to the behind of humerus.,Clin

15、ical manifestation and diagnosis 1.the history of trauma 2.symptom mon signs 4.specific signs： elastic fixation cavity of joint vacuity the triangle of elbow is isturbance 5, X ray 6, Complication injury: blood vessels and nerve injury,treatment 1）anesthesia 2）reduction the signs of reduction: passi

16、ve motion is normal the marks of bone are normal the triangle of elblow is normal X ray confirm the reduction.,3）fixation fixation with plaster for 34 weeks and the elbow flex 4）functional training,Subluxation of radialis head,Mechanism of dislocation Proximal radioulnar joint is composed by radiali

17、s head and radialis notch of ulna ,annular ligament round it .the annular ligament is weak and radialis head is easy to be tract out from the annular ligament while there is traction along the limb, then part of the annular ligament is insetted into radialis head and humeral head minor. After childr

18、en grown up and the annular ligament developed, Subluxation of radialis head never happen again.,Clinical manifestation and diagnosis 1, history of traction on upper limb 2, pain in elbow 3, sign：tenderness on the site of radialis head. 4, x ray (-),Treatment manipulative reduction no fixation preve

19、nt strong traction on upper limb.,Dislocation of hip,Anatomy,Causes of dislocation high speed, high energy injury classification posterior dislocation anterior dislocation central dislocation,Posterior dislocation of hip,Mechanism of dislocation while hip is flexion, thigh adduct and pronate , viole

20、nce transmit from distal thigh to hip, then femoral head dislocate from acetabulum. If hip flex lightly, femoral head strike posterior acetabulum result in posterior acetabulum fracture,Clinical manifestation and diagnosis 1 history of trauma 2 symptom 3 common sign 4 special signs： 1) hip is flexio

21、n, adduction and pronation 2) elastic fixation 3) cavity of joint vacuity,5. great trochanter move up, femoral head can be touched from posterior hip 6. ischial nerve injury 7. x ray an CT,Treatment 1.manipulative reduction 2. fixation with skin traction for 3 weeks,2、operative treatment open reduct

22、ion is applied when manipulative reduction fail or there are fracture, ischial nerve injury.,Anterior dislocation of hip,Mechanism of dislocation while hip is extension, abduct and supination, violence transmit from distal thigh to hip, great trochanter touch superior acetabulum and became pivot poi

23、nt of lever, then femoral head level out from acetabulum.,Clinical manifestation and diagnosis 1 history of trauma 2 symptom 3 common sign 4 special signs： 1) hip is flexion, abduction and supination 2) elastic fixation 3) cavity of joint vacuity 5 , femoral head can be touched from groin 6 femoral

24、nerve injury 7 x ray an CT,Treatment 1. manipulative reduction 2. fixation with skin traction for 3 weeks,Central dislocation of hip,Mechanism of dislocation while strong violence strike great trochanter transmit along axis of femoral neck femoral head strike acetabulum central dislocation and aceta

25、bular fracture, femoral head intrudes into pelvic cavity.,Clinical manifestation and dignosis 1, history of trauma 2, pain and swell in iliac region 3, hemorrhagic shock 4, hip abduction and pronation 5, limb shortening 6, visceral injury: bladder, internal iliac vessels 7, x ray and CT,Treatment rescue treatment 1、non operative treatment traction 2、operative treatment for failure of non operative treatment , fracture and dislocation can not be reduce.,