骨折与脱位.ppt
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Dislocation of Joint
Dislocation ofshould Joint
Anatomical features of should
? The shoulder joint is not congruous.
? There are no discrete ligaments.
? No one ligamentous structure is taut in all positions of the joint.
? All the ligaments of the shoulderare slack in the resting position.
? There is a weak point.
X-ray
Normal shoulder
Left External Rotation
Left Internal Rotation
Left Axillary View
Shoulder Dislocation
? Causes
? fall onto an outstretched arm
? receive a direct hit from a contact sport
? do forceful throwing, lifting, or hitting
a Dislocation following a direct blow to the back of the shoulder
b Formation of a Broca-Hartmann pouch. The persistence of this pouch is thought to be the main factor responsible for recurrent dislocation.
c Mechanism of indirect dislocation
Classification
? Chronological:
? ACUTE: injury within the last 3 weeks
? CHRONIC: dislocation more than 3 weeks
? RECURRENT: multiple episodes of dislocations
?Anatomical
? ANTERIOR: most common type of dislocation, where the head of the humerus is in front of the shoulder joint.
? POSTERIOR: uncommon, and the most easily missed type dislocation, where the head is situated behind the shoulder joint.
Clinical Features
? Pain
? Deformity
? Bruising
? Numbness/Weakness
? Posterior dislocations usually missed
Typical deformity
? Anterior shoulder dislocation
Reduction
? Analgesia
Recurrent dislocation can be usuallyreduced immediately without anaesthetic
? K?cher method
? Hippocratic method
? Collar and cuff for 1-3 wks for first dislocation
? Arthroscopic stapling in young patients
Hippocratic method
K?cher method
Complications
? Examine for axillary nerve palsy
? associated fracture
? brachial plexus injury and vascular damage
? X-ray before reduction except for a knownrecurrent dislocation
Hip Dislocation
? Definition
A hip dislocation occurs when the ball of the thighbone (femur) is moved out of its place within the socket of the pelvic bone (acetabulum). This ball and socket structure forms the hip joint.
The Hip Joint
The anatomy ofthe hip joint
Pathogenesis
? Hip dislocations are relatively rare and severe injuries. They are often associated with fractures of the pelvis.
? Severe falls, especially from heights
? Motor vehicle accidents, including motorcycles
? Sports injuries
Risk Factors
? A risk factor is something that increases your chance of getting a disease, condition or injury.
? Prior hip replacement surgery
? Abnormal hip joint
? Alcohol use
? Poor muscle control or weakness leading to falls
Classification
Posterior dislocation: Anterior dislocation:
Adducted, internally abducted, externally
rotated and flexedrotated and flexed
NOTES
? Posterior dislocation is much commoner than anterior dislocation,it accounts for 90% of hip dislocation
? Posterior dislocation maybe associated with a fracture of the posterior rim of the acetabulum
Central dislocation
A posterior dislocation of the left hip
An anterior dislocation on the right side
? A posterior fracture dislocation of the left hip
A posterior dislocation of the left hip, and an anterior dislocation on the right side
A central dislocation of left hip joint
Symptoms
? Severe pain in the hip, especially when attempting to move the leg
? Leg on the affected side appears shorter than the other leg
? Hip joint appears deformed
? Pain or numbness along the sciatic nerve area (back of thighs) if the dislocation presses on this nerve
Diagnosis
? painful hip held in flexion, adduction and internal rotation
? Sciatic nerve palsy
? X-ray - Only an AP X-ray is necessary
? CT Scan to view associated fractures of the pelvis
Treatment
? Closed Reduction
? Open Reduction
If the thigh or pelvic bones are broken, along with the dislocation
eg central dislocation
Complications
? Early recurrent dislocation
? Sciatic nerve damage
? Avascular necrosis of the femoral head
? Traumatic ossification
? Osteoarthritis
? Fracture head of femur
? Closed reduction under sedation was attempted in the emergency unit. Further radiographs of the left hip revealed that the hip was still dislocated with possible fracture fragment or soft tissue interposition
? The patient had a CT of the left hip which showed that the posterior lip fracture of the acetabulum was interposed, preventing the reduction of the hip dislocation
? The fracture was fixed with two partially threaded cancellous screws
Dislocation of Joint
Dislocation ofshould Joint
Anatomical features of should
? The shoulder joint is not congruous.
? There are no discrete ligaments.
? No one ligamentous structure is taut in all positions of the joint.
? All the ligaments of the shoulderare slack in the resting position.
? There is a weak point.
X-ray
Normal shoulder
Left External Rotation
Left Internal Rotation
Left Axillary View
Shoulder Dislocation
? Causes
? fall onto an outstretched arm
? receive a direct hit from a contact sport
? do forceful throwing, lifting, or hitting
a Dislocation following a direct blow to the back of the shoulder
b Formation of a Broca-Hartmann pouch. The persistence of this pouch is thought to be the main factor responsible for recurrent dislocation.
c Mechanism of indirect dislocation
Classification
? Chronological:
? ACUTE: injury within the last 3 weeks
? CHRONIC: dislocation more than 3 weeks
? RECURRENT: multiple episodes of dislocations
?Anatomical
? ANTERIOR: most common type of dislocation, where the head of the humerus is in front of the shoulder joint.
? POSTERIOR: uncommon, and the most easily missed type dislocation, where the head is situated behind the shoulder joint.
Clinical Features
? Pain
? Deformity
? Bruising
? Numbness/Weakness
? Posterior dislocations usually missed
Typical deformity
? Anterior shoulder dislocation
Reduction
? Analgesia
Recurrent dislocation can be usuallyreduced immediately without anaesthetic
? K?cher method
? Hippocratic method
? Collar and cuff for 1-3 wks for first dislocation
? Arthroscopic stapling in young patients
Hippocratic method
K?cher method
Complications
? Examine for axillary nerve palsy
? associated fracture
? brachial plexus injury and vascular damage
? X-ray before reduction except for a knownrecurrent dislocation
Hip Dislocation
? Definition
A hip dislocation occurs when the ball of the thighbone (femur) is moved out of its place within the socket of the pelvic bone (acetabulum). This ball and socket structure forms the hip joint.
The Hip Joint
The anatomy ofthe hip joint
Pathogenesis
? Hip dislocations are relatively rare and severe injuries. They are often associated with fractures of the pelvis.
? Severe falls, especially from heights
? Motor vehicle accidents, including motorcycles
? Sports injuries
Risk Factors
? A risk factor is something that increases your chance of getting a disease, condition or injury.
? Prior hip replacement surgery
? Abnormal hip joint
? Alcohol use
? Poor muscle control or weakness leading to falls
Classification
Posterior dislocation: Anterior dislocation:
Adducted, internally abducted, externally
rotated and flexedrotated and flexed
NOTES
? Posterior dislocation is much commoner than anterior dislocation,it accounts for 90% of hip dislocation
? Posterior dislocation maybe associated with a fracture of the posterior rim of the acetabulum
Central dislocation
A posterior dislocation of the left hip
An anterior dislocation on the right side
? A posterior fracture dislocation of the left hip
A posterior dislocation of the left hip, and an anterior dislocation on the right side
A central dislocation of left hip joint
Symptoms
? Severe pain in the hip, especially when attempting to move the leg
? Leg on the affected side appears shorter than the other leg
? Hip joint appears deformed
? Pain or numbness along the sciatic nerve area (back of thighs) if the dislocation presses on this nerve
Diagnosis
? painful hip held in flexion, adduction and internal rotation
? Sciatic nerve palsy
? X-ray - Only an AP X-ray is necessary
? CT Scan to view associated fractures of the pelvis
Treatment
? Closed Reduction
? Open Reduction
If the thigh or pelvic bones are broken, along with the dislocation
eg central dislocation
Complications
? Early recurrent dislocation
? Sciatic nerve damage
? Avascular necrosis of the femoral head
? Traumatic ossification
? Osteoarthritis
? Fracture head of femur
? Closed reduction under sedation was attempted in the emergency unit. Further radiographs of the left hip revealed that the hip was still dislocated with possible fracture fragment or soft tissue interposition
? The patient had a CT of the left hip which showed that the posterior lip fracture of the acetabulum was interposed, preventing the reduction of the hip dislocation
? The fracture was fixed with two partially threaded cancellous screws
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