Dislocation is understood as a persistent separation of the articular surfaces of bones, which occurs under the influence of mechanical force (trauma) or diseases that are accompanied by the destruction of cartilage (arthrosis, arthritis). With dislocations, the joint capsule may be damaged or remain intact. If there is complete separation of the articular surfaces of the bones, then they speak of complete dislocation. If the separation is incomplete and the articular surfaces have points of contact, then a diagnosis of “subluxation” is made. In addition, congenital and acquired dislocations are distinguished.
Causes of dislocations
Damage in adolescents and schoolchildren occurs under increased load, for example, if a child is involved in strength sports and does not successfully pick up a weight, the joint becomes displaced. Sometimes an injury occurs during physical education during incorrect pull-ups on the horizontal bar.
Children from one to five years old land on outstretched arms when falling. The fulcrum becomes the elbow, the ligaments of which cannot support the entire weight and cannot hold the joint in place.
Often parents themselves provoke dislocation in their children by pulling their hands. Due to a sharp jerk, the head of the joint comes out of its cavity.
Prevention of dislocations
Prevention of dislocations is based on the formation of a balanced menu for the child’s nutrition. A sufficient amount of minerals and vitamins in food will provide the baby’s joints and bones with sufficient strength to painlessly endure falls that are inevitable during childhood activities.
Parents should also take care of the physical development of their growing sons and daughters. Swimming, running, and playing with a ball help improve children's coordination and strengthen skeletal bones and muscle tissue. Moms and dads should remember that babies’ bodies cannot bear the same stress as adults.
Kinds
To choose treatment tactics, it is important to correctly classify the pathology. First of all, the doctor distinguishes between open and closed dislocations. In the first case, the injury occurs when struck by a bent elbow, and in the second case, when falling on an outstretched arm.
The severity is influenced by the area where the injury occurred. The joint is completely displaced if the blow is targeted to the elbow. Partial displacement or subluxation occurs when there is an indirect blow to the elbow area.
Depending on which direction the elbow is bent, the dislocation is divided into:
- rear. The radial head can be felt because the joint is flexed 140° in the opposite direction. This type is often diagnosed due to the immature strength of the child’s bones;
- front. The heads of the radius and ulna are displaced, and the elbow itself flexes anatomically correctly;
- side. Bone protrusions are exposed and ligaments are torn. More difficult to tolerate.
Possible complications
The most common complication of injuries to the joint capsules of the upper extremities is fibrosis. Overgrowth of connective tissue occurs as a result of untimely treatment of a dislocation, a shortened period of immobilization, or significant damage to muscles and tendons.
A dislocation of the elbow joint, accompanied by symptoms of other arm injuries in a child, requires the fastest possible surgical intervention. Thus, an open fracture of the radius of the forearm in combination with damage to the articular tissues can provoke contracture. Restrictions in arm mobility after the child’s recovery can only be avoided if timely medical care is received.
Symptoms
The first sign of a dislocated elbow in a child is severe swelling, loss of sensation in the affected limb, immobilization of the forearm and absence of a pulse.
You should be concerned if your baby has:
- swelling increases within several hours after injury;
- the configuration of the joint has changed;
- hand in an unusual position. He cannot straighten it and holds it with his good hand;
- the skin around the joint is red and feels hot when touched.
In this case, do not hesitate to visit the clinic and immediately make an appointment with a traumatologist.
Sometimes reduction of a dislocated elbow joint in children is not carried out immediately. The fact is that with a closed dislocation, the pain increases gradually. When a child is small, he cannot tell his parents about discomfort. Already when the temperature rises and the pain increases when lifting, the mother notices changes.
Signs of dislocation
- sharp pain in the elbow
- restriction of any movements (if you want to move your arm, sharp pain occurs)
- the appearance of swelling in the elbow joint
- numbness and loss of sensation in the injured arm
- fever or chills
- rapid rise in temperature
Treatment methods
If a dislocation of the elbow joint is diagnosed in a newborn baby, then the reduction of the elbow, as well as the reduction of the hip joint in a child, is carried out immediately after the end of childbirth so that the function of the elbow or hip is restored and the baby is able to move the limbs.
The procedure is performed under general anesthesia so as not to frighten the child and to set the arm painlessly. The traumatologist stretches the joint, directs the head inside the joint cavity, and then bends the elbow. Treatment ends with the application of a splint and immobilization of the limb. Immobilization lasts from three weeks to two months.
Seeing a doctor
The baby’s parents will not be able to cure damage to the joint capsule on their own. If children detect symptoms of a dislocated elbow joint, adults should seek qualified help by taking the injured person to the hospital or inviting an emergency medical team to your home (if there are associated injuries).
Until doctors arrive, parents should ensure that the child's injured limb is immobilized. It is acceptable to apply a cold compress (wet towel) or ice. Taking analgesics or using anesthetics is not recommended, since without diagnostic procedures it is impossible to determine the extent of damage and possible contraindications to certain groups of drugs.
In a clinical setting, treatment of dislocations is carried out by a traumatologist, rheumatologist or surgeon. Doctors carry out the necessary diagnostic measures, develop a treatment strategy and determine the period for which the injured limb will be immobilized.
The ambulance team of JSC "Medicine" (academician Roitberg's clinic) will deliver a small patient with a dislocation to the clinic for diagnostic and therapeutic measures. The team is on call 24 hours a day.
Reduction of the elbow joint in our clinic
In our medical center, we not only treat dislocations, but also monitor the entire process of tissue fusion and develop rehabilitation measures to prevent complications. The rehabilitation program is compiled individually for each child, taking into account his mobility and the severity of the injury. Immediately after removing the plaster, to normalize blood circulation, the traumatologist refers you to physical therapy, offering several procedures to choose from. If negative consequences are identified, for example, nerve plexuses are damaged, then the clinic will provide a full range of services and a neurologist will join the treatment process.
Rehabilitation of dislocations in children
The rehabilitation program for children with congenital hip dislocation is divided into 4 periods:
- The preparatory period involves the appointment of individual physical therapy sessions, which are general strengthening and help stabilize the hip joint;
- Postoperative period. After the operation, a plaster cast is applied to the leg, which covers the belt and healthy thigh. Three days after surgical treatment, physiotherapy is prescribed, the purpose of which is to eliminate pain and inflammation. At the same time, breathing and therapeutic exercises are carried out, which includes exercises that stimulate the cardiovascular system, increase the tone and reactivity of the body;
- The next period of rehabilitation begins from the moment the plaster cast is removed, instead of which a “boot” is applied to prevent the rotation of the limb. To unload the joint, a system of blocks with loads of different weights is installed. During this period, it is important to ensure that all movements are careful and smooth, so passive gymnastics is prescribed, after which they begin to develop their own movements in the hip joint;
- The final period begins 9-10 months after surgical treatment. It coincides with the removal of metal fasteners that were installed previously. Rehabilitation activities are aimed at learning to walk. First, additional means are used (walkers, canes, etc.) without support on the sore leg, then partial support is allowed and, at the end of rehabilitation, full support without the use of additional means.
1.General information
Each joint, that is, a movable articulation of two bone structures, has a certain “degree of freedom” - and only within these limits are natural rotational, flexion-extension and other movements possible for a person.
If the head of one of the bones goes beyond the boundaries of the anatomical bed allocated to it by nature and cannot return on its own, this situation is called a dislocation or subluxation. The difference between one and the other can often be established only during instrumental examination (for example, x-ray): a complete dislocation is accompanied by destruction of the ligamentous apparatus; with subluxation, the ligaments can be stretched, but not torn. Another criterion is the presence or absence of contact of the articular surfaces: with subluxation they touch at least partially, with complete dislocation there is no contact.
Symptomatically, dislocation and subluxation are very similar - the joint turns red and swells, the limb is in an unnatural position, its mobility is sharply limited (with concomitant nerve damage, tactile sensitivity may also be impaired), the victim usually experiences severe pain.
It seems quite logical, from a mechanical and anatomical point of view, a trend long known to traumatologists: the more complex the joint, the more complex, diverse and dangerous its dislocations.
Shoulder dislocations lead in trauma statistics. Dislocations and subluxations of the forearm are in second place in terms of frequency of occurrence (20-25% of all recorded traumatic dislocations). According to some data, the gender and age structure of victims is dominated by males aged 10-30 years and females over 50 years old.
A dislocation (subluxation) of the forearm that has not been reduced in a closed manner for two weeks or more is considered old.
A must read! Help with treatment and hospitalization!
TREATMENT OF DISLOCATIONS AND SUBLUVATIONS OF JOINTS
A joint dislocation is a displacement of the articular ends of bones with their complete divergence, which causes dysfunction of the joint.
Dislocation can be complete or incomplete - the so-called “subluxation”.
A joint subluxation is an incomplete dislocation of a joint in which the articulating surfaces of the bones are displaced, but the contact between them is maintained.
TYPES OF DISLOCATIONS AND SUBLUVATIONS OF JOINTS
Dislocations and subluxations can be congenital or acquired.
Congenital dislocation and subluxation of the joint
associated with anomalies of intrauterine development of the fetus - underdevelopment of the glenoid cavity and femoral head (hip dysplasia).
Acquired subluxation and dislocation of a joint
are divided into traumatic (associated with extreme load, accident, fall, blow, tugging of a child by the hand, etc.) and pathological, i.e. associated with any disease of the musculoskeletal system (for example, osteomyelitis, poliomyelitis).
Traumatic dislocations and subluxations are often accompanied by rupture of the joint capsule, and tendons, muscles, bones, blood vessels and nerves can also be damaged.
Traumatic dislocations and subluxations are common: vertebra (spinal joint), shoulder and forearm (elbow), femur (hip dislocation), shin bone, patella, fingers, feet, jaw.
When the skin is damaged during a traumatic (open) dislocation, the wound communicates with the joint cavity.
Most dislocations are a fairly serious injury that leads to further functional impairment and can sometimes be life-threatening, such as a dislocation of the cervical vertebrae (vertebrae in the cervical spine).
SYMPTOMS OF DISLOCATIONS AND SUBLUVATIONS OF JOINTS
Signs by which you can recognize a dislocated joint
(subluxation) - sharp pain, change in the shape of the joint, impossibility or limitation of movement in the joint.
When a vertebra (spinal joint) is dislocated (subluxated), the patient experiences sharp pain and limited mobility in the damaged part of the spine.
PROGNOSIS FOR TREATMENT OF DISLOCATIONS AND SUBLUXATIONS OF JOINTS
Prognosis for treatment of dislocation or subluxation of a joint
generally favorable.
With timely and adequate therapy, complete restoration of working capacity occurs using non-surgical treatment methods.
1. Emergency measures:
- First of all, it is necessary to take measures to immobilize (fix and immobilize) the damaged joint. It is most correct to apply a splint, but if it is unrealistic to apply it, improvised means are also suitable for immobilization - a scarf, a scarf, etc.
- It is highly advisable to apply cold to the damaged joint. The most effective option is to take the ice out of the freezer, crush it a little, and place it in a sealed and elastic bag (for example, a thin-walled rubber heating pad or several bags or bags) and apply it to the damaged area. If there is no ice, you can use a wet towel or handkerchief placed in a sealed bag or bag.
2. Reduction of dislocations and subluxations of joints
In the absence of bone damage (fractures and cracks), it is recommended to reduce dislocations and subluxations of joints
, and it is advisable to do this without delay, since swelling will further develop and the dislocation (subluxation) will pass into an old form (stage). This will lead to the fact that it will be much more difficult to perform the reduction, up to the impossibility of non-surgical reduction and referral for surgery.
A qualified chiropractor should correct a dislocation (subluxation). Self-direction is unacceptable - there is a high probability of additional injury and aggravation of the situation!
3. Rehabilitation after reduction of dislocations and subluxations of joints
After reduction of a dislocation (subluxation), it is necessary to undergo a course of rehabilitation, the duration of which depends on the severity of the injury. Typically, therapeutic massage, physiotherapy, drug therapy, physical therapy (physical therapy) and other methods are used.
In the process of treating dislocations (subluxations) of joints, it is recommended to use the most gentle regimen for the damaged joint, excluding physical activity, during treatment and several days after completion of the course of treatment!
Treatment
A minor injury may heal on its own.
Conservative treatment is indicated for most patients who manage to return to their usual activities. Conservative treatment includes: the use of NSAIDs (ibuprofen aspirin), analgesics, cold compresses on the injured area, limiting the load on the elbow, wearing a splint, and physical therapy. Surgical treatment is generally required only for a small number of patients with complete ligament rupture or those with persistent pain, hand dysfunction, or risk of ligament rupture. Most often, these patients are baseball players.
Operation Tommy John. Patients with an acute ligament tear, those who have failed conservative treatment, and those who wish to continue playing baseball require surgical reconstruction (repairing the ligament using other tissues). This operation is known as the "Tommy John" operation and is named after the player whose career was successfully saved when the ligament was reconstructed by Dr. Frank Jobe.
Ligament reconstruction can be performed using a variety of patient-derived soft tissue grafts, but is most often performed using the palmaris tendon of the forearm. This is explained by the fact that this tendon provides biomechanical characteristics that are similar to the native ligament, and since there are no consequences from its absence, it is an ideal replacement for the ligament. Some patients do not initially have a palmaris tendon and therefore require alternative grafts for reconstruction, such as leg extensor tendons.
4.Treatment
In the acute period of dislocation or subluxation of the forearm, the method of choice is almost always closed reduction, the specific technique of which is determined by the clinical picture. This is especially true for pediatric and young patients, when the priority solution is minimal invasiveness and preservation of the integrity of the joint and periarticular tissues. This reduction is carried out either under local anesthesia or general anesthesia (depending on a number of individual factors).
Of course, the minimum condition for this is a timely visit to a doctor (attempts to straighten the joint on your own usually end in serious complications). The deadline is usually 21-28 days from the moment of dislocation - after which ossification makes conservative reduction impossible, i.e. It is no longer possible to do without surgery. However, in some cases, when an elderly or senile person with a chronic dislocation/subluxation of the forearm has no pain, and the functioning of the arm is preserved to a degree acceptable to the patient, surgery is also considered undesirable.
In all other cases, with chronic dislocation of the forearm, surgical intervention with arthroplasty is performed - reduction and restoration of the normal anatomy of the elbow joint. Hinge-distraction devices are used according to indications.
A common consequence of such a dislocation or subluxation is a significant decrease in strength in the injured limb.