Dislocation
Dislocation
During injury, damage to the ligamentous apparatus occurs. It is because of this that swelling and swelling occur in the area of the damaged area, and stiffness of movement is noted. A dislocation always causes a leg deformity. This is a clear sign by which you can identify an injury even before visiting a specialist.
The knee is made up of two separate joints, each of which can be everted. The patella experiences peak loads during the transfer of muscle mass during movement and during flexion and extension of the limb. Correct functioning of the patella is ensured by centering. When this function is lost, a dislocation of the cup, or, more correctly, the patella, occurs.
Habitual dislocation - symptoms and treatment
Conservative (non-surgical) therapy for habitual dislocation is ineffective. An attempt at such treatment is advisable if the dislocation is the result of premature load on the affected limb during treatment of the primary dislocation (failure to comply with the required time frame for immobilizing the limb). In other situations surgery , the purpose of which is to restore damaged ligamentous, cartilaginous or other soft tissue structures [4][6]. It is planned, so it does not require haste or urgency and allows it to be performed at a time convenient for the patient.
Before starting an operation under anesthesia, full preparation - blood and urine tests, biochemical and functional studies of internal organs (for example, electrocardiography), consultation with a therapist. These examinations are necessary to exclude concomitant diseases that may become an obstacle to anesthesia and surgery. Preoperative preparation also involves obtaining the results of visual studies of the joint - radiography in two projections, MRI or CT, ultrasound of the joint [3].
Preference in treatment is given to low-traumatic arthroscopic interventions . This creates the prerequisites for rapid rehabilitation and complete restoration of the joint and limb within a few months. , classic “open” joint surgery can be performed . It involves arthrotomy (opening the joint cavity with an incision), examining the joint, identifying the causes leading to habitual dislocation, and eliminating them using one of the known methods. Many techniques have been proposed for both arthroscopic and open operations. In arthroscopic interventions, refixation of torn structures (re-fixation) to the bony protrusions of the joint is effectively used. For fixation, special metal structures are used - anchor clamps. Using the principle of an anchor, they hold the fixed ligaments and tendons until they fuse with the bone.
A favorable prognosis is also achievable with refixation with biodegradable materials . This means that for fixation they use a material that, after fusion of the body’s own tissues, will “resolve” without leaving foreign bodies behind.
In classical operations, the joint is examined and “strengthened” with one of many surgical techniques that are more suitable for the individual. In this case, they use the technique of surgery on the joint capsule, surgery on the ligamentous-muscular apparatus, surgery on the bones of the joint and combined techniques (combining all of the above) [2].
The postoperative period requires scrupulous adherence to the timing of the load on the joint. It is necessary to limit the load depending on the type of joint, gradually increasing and dosing its intensity. Typically, the period of movement restriction ranges from several weeks to several months. Rehabilitation is extremely important and must be carried out with care to avoid re-dislocation and at the same time not lead to joint stiffness due to a delay in the onset of movement in the joint [1].
Reasons for the development of the disease
There can be several reasons for a dislocation. Most often, the injury is provoked by a sharp mechanical force in the area of the patella (impact). Less commonly, pathology is caused by a sharp contraction of a muscle, for example, during a fall from a height, an accident, or during sports training. In addition, specialists from Dr. Glazkov’s clinics emphasize that there are other factors whose presence predisposes to the development of the disease. This is a congenital or acquired anomaly that provokes a violation of the structure of the musculoskeletal system. If we are talking about a congenital defect, it should be noted that the defect manifests itself differently in boys and girls, therefore the therapeutic methods prescribed by specialists are also different.
Risk factors
Of course, no one is immune from a knee injury, but there are certain factors that can increase the likelihood of its occurrence:
- Excess weight . It increases the load on the joint parts even during normal movements - when walking, climbing or descending stairs. Moreover, heavy weight increases the risk of arthritis and arthrosis and destroys articular cartilage.
- Poorly developed muscular system . Well-trained muscles allow you to hold joints, increase range of motion if necessary, and protect against injury. If the muscles are very poorly developed, this leads to much more frequent injuries.
- Presence of old injuries and pathologies . Various inflammatory diseases, destruction of cartilage and bone tissue, insufficient tissue nutrition, as well as poorly healed injuries significantly increase the risk of various types of ailments.
- Participation in individual sports . Thus, skiers, basketball players, football players, hockey players, as well as runners (especially those who jog) are at risk.
swelling on the knee
swelling on the knee
If, after a fall or other injury, a person notices one or several symptoms of a dislocation, you should immediately contact a specialized clinic for help. The sooner therapeutic measures are taken, the higher the chance of a positive treatment outcome. You can also determine a dislocation yourself due to the loss of sensitivity in the foot area and its pallor. Such symptoms manifest themselves as a result of impaired blood flow.
Diagnosis of knee injuries
The first thing the doctor does is collect anamnesis. The doctor carefully collects information about how the injury occurred, whether the patient has any pathologies, and what lifestyle he leads. In addition to clinical assessment, measures such as radiography, laboratory tests, magnetic resonance imaging, computed tomography may be required. Through examination, it is possible to identify the location - a rupture of the quadriceps tendon (in this case the patella is displaced to the lower side), a rupture of the patellar ligament (in this case it is displaced to the upper part), a transverse fracture (by palpation you can feel the boundaries between different fragments of the bone). Severe swelling may interfere with identifying the problem. If the swelling is very large, you cannot do without a CT or MRI. In addition, the possibility of joint extension is assessed. X-rays can reveal displacement, but sometimes they show that everything is normal even if there is serious damage.
Dislocation of damage
Most often, knee dislocation occurs in the cap area. This can be determined by its characteristic jumping out of the riverbed. Such symptoms provoke not only pain, but can also cause such a serious disease as arthrosis. Children and women wearing high-heeled shoes most often suffer from injury. Often, traumatologists have to diagnose bilateral dislocations. The pathology is accompanied by:
- the occurrence of severe pain;
- leg deformity;
- swelling;
- bent leg position in a relaxed state;
- development of hemorthrosis.
Without qualified medical assistance, it is difficult to cope with an injury on your own. At Dr. Glazkov’s clinic, the patient will undergo a detailed diagnosis, during which the complexity of the situation will be revealed, after which they will be able to prescribe the necessary therapy. After providing first aid, the patient can be treated on an outpatient basis, visiting his doctor only on designated days.
Structure and functions of the patella.
The patella is a large sesamoid (located in the thickness of the tendon) bone, which is located in the anterior part of the knee joint. Otherwise it is called “patella”. It is covered with cartilage tissue on the inside, facing the articular cavity. Muscle tendons, patellar ligaments are attached to it, and also a ligament extends inward from it, which is attached to the femur. The main function is protective (covers the structures of the joint from the front surface), as well as stabilizing (prevents displacement of the tibia and femur relative to each other).
reduction of the joint
realignment of the joint
Dislocation is considered a serious, dangerous injury that must be treated exclusively in a medical facility. Independent action in resolving this issue is excluded. The most common method of restoration is to realign the joint, after which it returns to its normal position. The specialist must take the time to eliminate concomitant symptoms, in particular hemorthrosis. To do this, a puncture is made, cold compresses or a splint are applied.
In the most serious cases, the patient may require surgery, followed by a long rehabilitation process, accompanied by the supervision of the attending physician. Surgery is prescribed only in case of complete rupture of tendons or ligaments. The modern equipment that Dr. Glazkov’s clinic has allows us to consider the surgical intervention minimally invasive, so the recovery period is also minimal.
Rehabilitation after kneecap dislocations
Recovery after arthroscopic surgery, due to its minimally invasive nature, occurs quite quickly. However, in this case, strict adherence to the doctor’s recommendations is necessary. The use of orthoses or braces may be recommended for the first time after surgery. A course of intra-articular injections of hyaluronic acid may be recommended. Physiotherapy promotes rapid restoration of joint tissue and muscles. As the swelling of the joint decreases, its motor activity is gradually increased. Kinesiotherapy and mechanotherapy are prescribed. After a course of rehabilitation measures, patients quickly return to their normal lives, and athletes return to training.
For diagnosis and effective treatment of dislocations and other injuries, contact our clinic!
Features of the structure of the knee
The patella is a rounded bone that covers the articular apparatus of the knee in front (located in a small depression). Fixation of the patella is possible thanks to the internal and external supporting ligaments, the quadriceps femoris muscle, and powerful cruciate ligaments.
The patella plays the role of a protective mechanism that prevents lateral displacement, thereby ensuring the safety of the joint, ligaments, and other tissues. The bone is the first to suffer from any mechanical impact, so patellar dislocation is considered a fairly common injury.
Basics of treatment: how to adjust the knee?
Before starting treatment, the traumatologist must conduct a diagnosis to obtain a complete clinical picture. Using an x-ray, the doctor can obtain the necessary information about the injury and decide how to return the kneecap to its place. Reduction is carried out under general anesthesia. The leg is fully bent and extended to relax the tendons. Then the kneecap is straightened and the joints fall into place. After the manipulation, a plaster cast is applied. Usually the patient stays in it for 2-3 weeks, during which time the capsule is restored.
The procedure will increase blood circulation.
After removing the plaster, doctors prescribe massage procedures for the patient's lower leg and thigh. It is recommended to gradually develop the knee by performing simple movements. Over time, increase the amplitude of execution. Patients are prescribed painkillers and anti-inflammatory drugs. Full cure and restoration of functionality occurs approximately 3-4 months after completion of the course of therapy.
Prevention
In order to avoid recurrences of patellar dislocation, it is necessary to perform a set of physical activities daily; they will help the patient strengthen the musculo-ligamentous apparatus of the knee, which will not allow the patella to move later. At the same time, it is better not to do heavy loads and sudden movements, so you should avoid extreme sports, as well as heavy physical activity. Patellar dislocation must be treated without fail; this condition cannot be cured on its own. If this is not done, it can subsequently lead to serious and dangerous complications.
Classification of patellar injuries
Existing types of dislocations:
- lateral dislocation;
- vertical (the joint space is blocked);
- rotational (the patella is rotated around its axis vertically).
Damage occurs:
- spontaneously appearing (occurs after a period of normal bone alignment);
- permanently existing (not eliminated after bone reposition);
- habitual (after each movement of the joint the bone moves away from its normal position).
Medical statistics confirm that more often patients turn to a traumatologist with an external dislocation, less often with an internal dislocation. Vertical and rotational types of dislocations are too rare.
The same applies to traumatic dislocations, however, they are dangerous due to the occurrence of relapses, which means a transition to a more serious stage (the dislocation becomes habitual).
Hip dislocation in children
Hip dysplasia is a common pathology of the musculoskeletal system in newborns, accounting for about 3% of all orthopedic diseases. It occurs due to improper formation of the joint in the prenatal period. According to statistics, unilateral dislocations occur seven times more often than bilateral ones, and in girls the pathology is detected five times more often than in boys.
50% of all hip dysplasia develops in children born in breech presentation. However, the nature of obstetric care and the mechanism of labor itself do not in any way affect the occurrence of pathology. This confirms the presence of hip deformity in babies born by caesarean section.
The group of hip dysplasias in children includes preluxation, subluxation, dislocation and radiologically immature hip joint. Diseases are usually diagnosed in early childhood through routine examinations by a pediatrician and orthopedist. Sometimes the pathology is detected much later, when the child begins to walk.
- visible shortening of the affected leg;
- asymmetrical arrangement of the gluteal, femoral and popliteal folds;
- external rotation of the limb, especially noticeable during sleep;
- the appearance of a characteristic crunch when the legs are abducted;
- inability to abduct a limb bent at the hip joint by more than 70-90 degrees;
- displacement of the femoral head when palpated.
In children over 1 year of age, congenital pathology manifests itself as an unsteady gait and lameness. The child has a curvature of the spine in the lumbar region. Sick children usually begin to walk later than healthy ones. Treatment of dislocations and subluxations of the hip joint in children begins in the first weeks of life. To combat pathology, wide swaddling, Pavlik stirrups, and special therapeutic splints are used. Along with this, the child is prescribed physiotherapeutic procedures, massage, and physical therapy. If conservative therapy is ineffective, the baby undergoes open reduction with arthroplasty.
The most suitable age for surgical intervention in a child is considered to be 2-3 years of age.
Therapeutic measures in the postoperative period
After making sure that the dislocation has been successfully reduced, doctors apply a plaster splint to the lower limb. It fixes the ankle, knee, hip joints and reaches the lower back. The patient is then placed on bed rest for three to four weeks. After getting out of bed, a person walks with crutches for another month and a half to two months. The plaster is removed no earlier than 2-3 months after the injury.
In some cases, the patient undergoes skeletal traction for 3-4 weeks. To do this, a special needle is inserted into the tibia under anesthesia, onto which a weight is attached.
High-quality treatment for hip dislocation in adults must include rehabilitation. It includes a course of massage, therapeutic exercises and physiotherapeutic procedures. Complete rehabilitation helps restore normal functions of the lower limb and gives a person the opportunity to return to normal life.