Dislocation is a violation of the articulation of the articular surfaces of the bones (congruence), which occurs as a result of destructive processes in the joints (arthrosis, arthritis) or injury. In case of injuries under the action of mechanical forces, the ends of the bones are forced to shift from their normal position.
Even during uterine development, a person may be injured, which will cause dislocation. This type of damage accompanies people at all stages of life.
During dislocation, a violation of the integrity and functionality of the joint occurs. In severe cases, rupture of the joint capsule and damage to the ligaments, arteries and ganglia can be observed. Such a disease requires the intervention of specialists who will provide first aid to patients and prescribe constructive treatment.
Most often, dislocations occur during shocks and falls. Special risk groups are contact sportsmen (football, hockey, volleyball, etc.) or people involved in sports involving frequent falls (skis, skates).
The sprained joint is temporarily deformed and immobilized. The characteristic symptoms are severe pain and swelling. Dislocation must necessarily be reset by returning the displaced joint in its place.
Types of sprains
Dislocations are classified according to the degree of displacement, according to the origin and size of the joint that was displaced.
According to the degree of displacement, a dislocation can be complete, that is, one that is accompanied by a complete divergence of the ends of the joints, or incomplete (subluxation) - when the surfaces of the joints are partially in contact. A sprained joint is one that is farther from the body. The exceptions are the vertebrae (consider dislocated vertebra, which is higher), the clavicle, the shoulder (dislocation can be anterior and posterior).
Depending on the origin, sprains can be congenital and acquired. Congenital occur due to impaired fetal development of the child. A common pathology is dislocation of the hip joint (dysplasia), less common is dislocation of the knee joint. Acquired dislocations result from injuries or various diseases (arthritis, arthrosis, osteomyelitis, polio, etc.)
Sprains can also be open and closed. Closed dislocations occur without breaking the skin and tissues above the joint, and open dislocations - with the formation of a wound. Damage to the muscles, blood vessels, bones, tendons, or nerves makes the dislocation complicated. People speak of habitual dislocation in situations where, due to poor treatment, dislocation may recur even with minor exposure. Pathological dislocation, which is characteristic mainly of the hip and shoulder joints, occurs if the pathological process destroys the surface of the joints.
If the muscles surrounding the joint are prone to paralysis or paresis, they speak of a paralytic dislocation.
In addition, modern medicine identifies more than ten types of sprains, which can affect the following joints in the following parts of the body:
Dislocation can be complete (complete divergence of the articular ends) and incomplete - subluxation (the articular surfaces remain in partial contact). Distal (distant from the body) part of the limb is considered to be dislocated.
- the spine - the overlying vertebra is dislocated.
- clavicle (there are dislocations of the sternal and acromial end of the clavicle, but not dislocation of the scapula).
There are congenital and acquired dislocations.
Causes of dislocation
The origin of dislocations can be either congenital (in utero forming dislocation of the hip) or acquired (consequence of injury or inflammatory diseases of the tissues surrounding the joint).
The most common causes of joint dislocation are the following factors:
- a fall or a blow, with a sharp contact of the joint with a hard surface, for example, a fall with a blow to the elbow causes dislocation of the shoulder,
- sharp and significant muscle contraction,
- physical impact on the joint itself or on the area adjacent to it,
- unnatural and strong straightening or bending of the joint.
Symptoms of sprains
The most common symptoms of dislocation include:
- at the time of injury characteristic cotton is heard,
- swelling and swelling are formed around the injured joint (the most common symptom of dislocation),
- sharp and severe pain,
- in case of damage to the nerve endings, decrease in sensitivity,
- tingling and numbness,
- pale and cold skin,
- visual deformation, etc.
The specific symptoms of dislocation vary from the place in which the joint is injured.
Dislocations of the shoulder are the most common types of dislocation of traumatic origin (according to statistics - more than half of all cases). This fact is explained by the peculiarities of the anatomical structure of the shoulder joint: the disproportionate ratio of the articular surfaces, the anterior muscular section that is not strong enough by nature, a significant motor range in different planes, the volumetric capsule of the joint, etc.
Dislocation of the shoulder, as a rule, occurs as a result of indirect exposure, when falling on the elbow or forearm, in almost one hundred percent of cases it is accompanied by a rupture of the capsule, sometimes with damage to the rotational cuff and the separation of the large shoulder tubercle (in elderly patients).
Traumatic dislocation of the hip in the general statistics of dislocations is diagnosed relatively rarely (no more than 7 percent of the total number of cases). The ileal dislocation of the hip is the leader (85 percent), then the obturator, sciatic and supral dislocation of the thigh.
Subspecies of hip dislocations, depending on the directional force applied to the head, are classified as follows:
- nadlonny (front-upper dislocation of the thigh).
First aid for dislocation
In order to provide the victim with first aid for dislocation, it is necessary to fix (secure the immobility) of the limb in the position that it assumed after the injury; it is imperative to apply a cold compress to the injured joint.
Attempts at self-reduction of the dislocated joint are by no means unacceptable, since only an experienced doctor in the conditions of a medical institution will be able to determine precisely whether dislocation is combined with fractures or bone fractures.
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The information is generalized and is provided for informational purposes only. At the first signs of illness, consult a doctor. Self-treatment is dangerous for health!
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15. Dislocation of joints, classification of dislocations. Clinical symptoms, first aid, treatment
Dislocation called persistent displacement of the articular surfaces in violation of the integrity of the capsule-ligament apparatus of the joint. In the absence of contact of the articular surfaces of the bones, the dislocation is called complete, in the presence of partial contact, incomplete, or subluxation.
The following are known sprains:
1) traumatic - due to injury,
2) pathological - for diseases associated with the destruction of the ligamentous apparatus and the articular ends of the bones, for example, for tumors, inflammatory processes,
3) habitual dislocations - occur in patients suffering from sprain and joint capsules, often occur after multiple traumatic dislocations, are easily repositioned,
4) congenital sprains - more often as a result of insufficient or improper development of the surfaces of the hip joint. Dislocations of a week or more ago are called old and can only be reset promptly.
The main symptoms of dislocation are severe, sudden pain in the joint, lack of movement, a springy symptom, joint deformities, and a forced abnormal position of the limb. Therefore, the patient seeks to keep the limb in a forced abnormal position. The diagnosis of dislocation is confirmed by x-ray examination.
First aid It consists in immobilizing the limb with a splint, anesthesia and fast delivery to a medical institution. Suppression is performed under local or general anesthesia. To restore the normal anatomical relationships in the joint, several reduction methods are used. Reduction should be carried out carefully, without violence, so as not to cause additional injury. Urgent dislocation is performed by a surgeon or traumatologist. When habitual dislocations promptly strengthen the ligament apparatus.
16. Fractures of extremity bones, fracture classification. Clinical symptoms, first aid, treatment
Fracture called partial or complete violation of the integrity of the bone.
Fractures may be congenital and acquired. Congenital fractures occur in the prenatal period of development and are the result of the inferiority of the bony skeleton of the fetus. Allocate "obstetric" fractures resulting from birth trauma.
Acquired they are divided into traumatic (mechanical) and pathological, arising from bone damage by the pathological process (osteomyelitis, tuberculosis, tumors, etc.).
Fractures are called open in violation of the integrity of the skin and closed in which the integrity of the skin is preserved. Open fractures pose a great danger to the patient due to the threat of infection in the area of the fracture.
There are fractures of the spongy bones (scapula, sternum, ribs, pelvic bones, etc.) and tubular bones. In case of fractures of long tubular bones, diaphyseal, metaphysary and epiphyseal fractures are distinguished.
Epiphyseal (intra-articular) fractures are accompanied by damage to the articular surface of the bones and the development of hemarthrosis.
Metaphysical (periarticular) fractures are often impacted, without displacement of fragments.
Diaphyseals depending on the mechanism, there are fractures from compression or compression along the axis, for example, compression fractures of the spine, impacted fractures, fractures from flexion, fractures from twisting (spiral-shaped, spiral), tear-off fractures occurring with marked muscle contraction (a bone fragment in the zone of attaching the tendon muscle to the bone). Depending on the direction of the fracture plane with respect to the bone axis, there are transverse, longitudinal, oblique, and helical or spiral fracture types. At fractures, there is a displacement of bone fragments, which is associated with the mechanism of injury and muscle contraction of the damaged segment. There are several types of displacement of bone fragments: offset at an angle along the length, lateral (in width), rotational.
There are absolute (characteristic only for fractures) and relative (can be observed with other injuries) signs of fractures.
Absolute signs: limb deformity in the fracture zone, crepitus (crunch) of bone fragments, absolute shortening of the limb due to displacement along the length, pathological mobility in the fracture zone.
Relative signs: pain in the fracture zone, hematoma, edema, impaired function. These signs matter only if there are absolute signs. With impacted fractures, the symptom of “axial load” is informative: with careful loading along the bone axis, pain is in the fracture zone.
To clarify the diagnosis and identify the nature of the displacement of bone fragments produce x-rays in two projections.
Fusion (consolidation) of fractures. The basis of accretion of fractures is tissue regeneration, as a result of which a callus is formed. The periosteum, bone marrow, connective tissue surrounding the fracture site are involved in the formation of callus.
Principles of fracture treatment. The treatment of fractures is based on the comparison of bone fragments (reposition - return to the previous position) and keeping them in this position (fixation) until the formation of callus. The complex includes measures for rehabilitation in order to quickly restore muscle tone, volume of movement in the joints, limb function and disability.
Reposition. Before proceeding with the reposition, it is necessary to carefully anesthetize the fracture area into which 10-50 ml is injected. 1% solution of novocaine. After a thorough examination of the patient, taking into account the type of fracture, displacement of bone fragments, X-ray data are compared fragments. It is necessary to achieve their comparison without displacement and diastasis between them. When reposition of fractures of limb bones, the peripheral fragment is established according to the position of the central fragment.
Fixing - therapeutic immobilization of bone fractures is carried out with the help of a plaster cast, by stretching or by surgery.
Cutaneous and skeletal traction. The essence of the skin (adhesive plaster, glue) stretching lies in the fact that special straps are applied to the distal portion of the injured limb, which are glued to the skin, and are pulled out with a specially selected load for them with the help of cables. The limb is placed on a special tire, which gives it an average physiological position. On the bus there are special blocks for stretching in the right direction. The lower block is designed to extend the lower leg, upper - thigh, the front - to support the foot.
In those cases when a large load is required to hold the fragments, a skeletal one is used instead of skin traction. For its imposition under local anesthesia through the bone with the help of a special drill hold a metal needle. To the needle attach the bracket, which holds it in the tensioned position. The needle is held for the distal bone fragment in certain places. In case of fracture of the bones of the leg, through the heel bone, and in case of a fracture of the femur, through the tibial tuberosity or the metaphysis of the femur. The limb is placed on the tire, the rope is tied to the bracket with a load. For fractures of the bones of the upper extremities, stretching is applied by an elastic strain (rubber tube) using special diverting tires. For fractures of the spine, the patient is placed on the shield. The head end of the bed is raised, the upper torso is fixed with the help of special cotton-gauze rings or Glisson loop to the headboard. Traction is the weight of your own body.
Indications for surgical treatment is the impossibility of matching and retaining bone fragments by previous methods (plaster bandage, stretching). The most frequently resorted to surgical treatment for the interposition (pinching) of the soft tissue between the bone fragments and tear-off fractures. The principle of surgical treatment is that the bone fragments expose, match and fix them using special metal (osteosynthesis) pins, plates, screws, etc. After fusion of the bone fragments (usually 6-8 months), the metal structure fixing the bone fragments is removed.
For the fastest restoration of limb function in the treatment of fractures, physiotherapy, mechanical and physiotherapy are required. Exercise therapy is shown from the first days of injury for immobilized limbs and breathing exercises. Physical therapy and mechanotherapy prescribed to improve movements in the joints, treatment of contractures, increase muscle strength.
Qualified medical personnel, having ascertained the cause and type of damage, will first of all begin to reduce the dislocation. This procedure is quite painful and can cause severe pain or even shock. Therefore, local or general anesthesia is suggested for returning articular surfaces to normal physiological condition.
After the preparatory stage, the traumatologist performs the reduction of joint dislocation. The signal of the achieved effect is a characteristic click and a visual assessment of the anatomical position of the bones in the joint.
For further prevention of habitual dislocation, it is necessary to adhere to the recommendations of the treating doctor. Basically, this is a course of various physiotherapeutic procedures, namely:
In some cases, a plaster cast or fixation bandage is required.
In severe cases, surgery may be required. After surgery, the patient is under medical supervision for longer to prevent the development of infection and other complications. If diseases become the cause of injury, then their adequate therapy will help get rid of all the unpleasant consequences. It is important to eliminate the cause of the disease, not its symptoms.
Congenital bias requires special attention. Their treatment should start as soon as possible. In this case, apply the imposition of tires, orthopedic structures and even operational correction.
Any dislocation is accompanied by severe pain. Such sensations signal that it is necessary to stop movement in the affected joint and keep the limb at rest. To relieve the condition of the victim, there is a wide variety of painkillers.
The most effective drug that is in any first-aid kit is Analgin. You can replace it with Ibuprofen, Ketanov, Nimesulide. In a hospital setting, Novocain blockades are used to quickly achieve pain relief.
If necessary, one of the stages of treatment will be the removal of fluid from the joint through a puncture, washing the damaged joint with an antiseptic, as well as introducing Prednisolone and Hydrocortisone into its cavity.
Traditional medicine is rich in recipes to relieve trauma. For example, to reduce the pain will help the dough of flour and vinegar, which is applied as a fixing bandage. Broths and mixtures of herbs used as compresses have analgesic and regenerating properties. Enough effective infusion of mashed to a mushy state of wormwood or lavender in vegetable oil. How to apply a compress:
- Moisten the mixture thoroughly with a mixture of gauze, folded in several layers, and apply to the injured area.
- Be sure to bandage or tie with a scarf or scarf. Leave to act for a few hours.
Any methods of alternative medicine can be applied only after the reduction of dislocation and consultation with a doctor.
The main rules that the victim must adhere to are complete rest of the injured limb, stress reduction and good nutrition to recuperate and accelerate tissue regeneration.