Lec.2 Management of joint dislocations.pdf

Management of joint dislocations Lec.2 MSL Dr.Sarkawt S.Kakai Understanding Joint Dislocations: Definition: • A joint dislocation refers to the complete separation of two or more bones at an articulating joint, disrupting the normal alignment of the joint surfaces. Causes: • Dislocations commonly...

Management of joint dislocations Lec.2 MSL Dr.Sarkawt S.Kakai Understanding Joint Dislocations: Definition: • A joint dislocation refers to the complete separation of two or more bones at an articulating joint, disrupting the normal alignment of the joint surfaces. Causes: • Dislocations commonly result from trauma, falls, sports injuries, or motor vehicle accidents. Commonly Dislocated Joints: • Some frequently dislocated joints include the shoulder, elbow, finger, hip, knee, and ankle. Clinical Assessment: History: Gathering information about the mechanism of injury, previous dislocations, and associated symptoms. Physical Examination: Evaluating for deformity, swelling, bruising, loss of motion, and neurovascular status. Imaging: X-rays, CT scans, or MRIs may be necessary to confirm the diagnosis, assess associated fractures, and determine the optimal reduction technique. Reduction Techniques Closed Reduction: • A non-surgical technique involving the manual manipulation of the dislocated joint back into its normal position. This is usually performed under anesthesia or sedation. Open Reduction: • Surgical intervention may be necessary when closed reduction fails, or there are complicating factors such as fractures or severe soft tissue injuries. Post-Reduction Care Immobilization: • The joint is typically immobilized using splints, casts, or braces to prevent re-dislocation and promote healing. Physical Therapy: • Early mobilization and rehabilitation are essential for restoring joint function, preventing stiffness, and strengthening surrounding muscles. Pain Management: • Analgesics and anti-inflammatory medications may be prescribed to manage pain and reduce inflammation. Complications and Considerations • Recurrent Dislocations: • Some joints, like the shoulder, are more prone to recurrent dislocations and may require additional interventions. • Neurovascular Compromise: • Caution in monitoring neurovascular status is crucial to prevent complications such as nerve or blood vessel damage. • Compartment Syndrome: • In cases of severe dislocations with associated soft tissue injuries, compartment syndrome may develop and require immediate intervention. • Chronic unreduced dislocation: • Pain, deformity, shortening and decreased ROM Rehabilitation and Long-Term Follow-up • Gradual Range of Motion: • Physical therapy focuses on restoring joint range of motion gradually and safely. • Strength and Stability: • Exercises that strengthen the muscles around the joint are essential to prevent future dislocations. • Psychological Support: • Patients may experience anxiety or fear of reinjury, and counseling or support groups can be beneficial. Prevention • Protective Gear: • In sports and high-risk activities, appropriate protective gear can reduce the risk of joint dislocations. • Safety Measures: • Educating individuals about safety measures and fall prevention, especially in the elderly, is crucial. Shoulder Dislocation • Anterior (90%) • Posterior (4-10%) • Laxation erecta - true inferior Shoulder reduction techniques Relocation prevented by • Static forces • Joint capsule / lip of glenoid • Dynamic forces • Rotator cuff • Biceps • Trapezius / deltoid • Pectoralis • Hippocratic NO single best technique • Kocher’s • Milch • Stimson’s Hip dislocation Posterior (90%) Anterior (10%) Axial load in flexed adducted hip Load on abducted externally rotated hip Position: Flexion / adduction / internal rotation Position: Flexion / abduction / external rotation Knee dislocation Use position of tibia as reference Anterior (most common) Posterior Medial / lateral / rotational Suspect • Hyperextension • Force to anterior tibia with knee flexed • Valgus / varus / rotational forces • High injury force • Multiple ligamentous injury and Vascular injury Elbow dislocation • 2nd most common large joint dislocation • Simple • Complex • Radial head # • Coronoid # • Terrible triad • https://padlet.com/sarkawts83/jointdislocation-classification-aw1hjlhs2cj02ser