This document discusses musculoskeletal trauma, specifically fractures and dislocations. It defines fractures and describes factors that influence fracture healing such as the patient's age, fracture site and configuration. It also discusses common fracture patterns, complications of fracture healing, principles of fracture treatment including splinting and closed/open reduction, and classifications of open fractures. Additionally, it defines dislocations and describes specific fractures and injuries of the hand.
This document discusses musculoskeletal trauma, specifically fractures and dislocations. It defines fractures and describes factors that influence fracture healing such as the patient's age, fracture site and configuration. It also discusses common fracture patterns, complications of fracture healing, principles of fracture treatment including splinting and closed/open reduction, and classifications of open fractures. Additionally, it defines dislocations and describes specific fractures and injuries of the hand.
This document discusses musculoskeletal trauma, specifically fractures and dislocations. It defines fractures and describes factors that influence fracture healing such as the patient's age, fracture site and configuration. It also discusses common fracture patterns, complications of fracture healing, principles of fracture treatment including splinting and closed/open reduction, and classifications of open fractures. Additionally, it defines dislocations and describes specific fractures and injuries of the hand.
This document discusses musculoskeletal trauma, specifically fractures and dislocations. It defines fractures and describes factors that influence fracture healing such as the patient's age, fracture site and configuration. It also discusses common fracture patterns, complications of fracture healing, principles of fracture treatment including splinting and closed/open reduction, and classifications of open fractures. Additionally, it defines dislocations and describes specific fractures and injuries of the hand.
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MUSCULOSKELETAL TRAUMA
Dr. Nur Rachmat Lubis, SpOT
FRACTURE & DISLOCATION FRACTURE Definition : A fracture, whether of a bone, an epiphyseal plate or a cartilaginous joint surface, is simply a structural break in its continuity.
must be consider : surrounding soft tissue around the fracture site Physical factors in the Production of Fractures 1. Cortical Bone: can withstand compression and shearing forces better that it can withstand tension forces 2. Cancellous Bone/ spongious: Cant withstand compression. Can produced: Crush # / compression # Impacted # Descriptive Terms Pertaining to Fractures 1. Fracture site : Diaphyseal Metaphyseal Epiphyseal 2. Extent of Fracture: complete Incomplete 3. Configuration of #: 1. Transverse 2. Oblique 3. Spiral 4. Comminuted 1 2 3 4 4. Relationship of the Fracture Fragments to Each Other : Undisplaced Displaced : 1. Overriding 2. Angulated 3. Rotated 4. Distracted 5. Impacted 6. Shifted sideways
Relationship of the fracture fragments to each other caused by : Effects of Gravity Effects of muscle pull on the fragments 5. Relationship of the Fracture to the External Environment: Closed # Open #: Fracture fragment has penetrated the skin ( from within) Sharp object has penetrated the skin to # the bone (from without) 6. Complication : Uncomplicated Complicated: Local : Infection Systemic : Emboli, Sepsis
THE DIAGNOSIS OF FRACTURES HISTORY : Fall, Direct Trauma. Mechanism of injury. Common symptom of # : Localized pain. Decreased function of the involved part. THE DIAGNOSIS OF FRACTURES PHYSICAL EXAMINATION: INSPECTION ( LOOKING ): Swelling ( edema ) Deformity( angulations, rotation, shortening ) Abnormal movement Echymosis( subcutaneous extravasations of blood ) PALPATION ( FEELING ) : Localized tenderness at the # site. Crepitus (not necessary) RANGE OF MOVEMENT (ROM): Limitation. THE DIAGNOSIS OF FRACTURES !!!! CAREFULL ASSESSMENT Patients General Condition Search for associated injuries: Brain Spinal Cord Peripheral Nerves Major vessels Thoraces Abdominal viscera THE DIAGNOSIS OF FRACTURES RADIOGRAPHIC EXAMINATION: # : PHYSICAL EXAMINATION Confirmation by X-Ray Accurate Diagnosis To determine extent and configuration of the fracture. Include entire length of the bone and the joints at each end. 2 Projection : AP / Lat, particularly oblique Spine and pelvis : (+) CT THE NORMAL HEALING OF FRACTURES 1. Cortical bone (diaphyseal bone/ tubular bone) # torn of blood vessels, canaliculi, Haversian canal on the # site Osteocyte in the lacunae
A vascular Bleeding from periosteum 1. Fracture Hematoma
Localized on the end of fragment # Osteogenic cells from periosteum formed External callus From endosteum Internal callus Cartilage callus change in to bone by Endochondral Ossification 2 Clinical Union ( fracture line still apparent) 3 Consolidation ( Radiographic Union ) 4 Remodeling THE NORMAL HEALING OF FRACTURES 2. CANCELLOUS BONE Internal Fracture Hematoma osteogenic cells from trabeculae
Internal callus
Clinical Union
Consolidation THE TIME REQUIRED FOR UNCOMPLICATED # HEALING FACTOR INFLUENCE: 1. Age of the patient Younger age, the healing rate faster. Example : femur # after birth union 3 weeks femur # on the age 8 year union 8 weeks femur # on the age 12 year union 12 weeks femur # on the age 20 th/> union 20 weeks HEALING TIME UNCOMPLICATED # 2. # Site and Configuration # through bones that are surrounded by muscle >union faster cancellous bone # > union faster than cortical bone long oblique / spiral # > union faster than transverse # WAKTU PENYEMBUHAN # UNCOMPLICATED 3. Initial Displacement of the Fracture : undisplaced #, intact periosteum heal twice as rapidly as displaced #
4. Blood supply to the Fragments : If both fracture fragments have a good blood supply healing faster ABNORMAL HEALING OF FRACTURES MALUNION Heal normally expected time but in unsatisfactory position with residual bone deformity DELAYED UNION union time longer than normal NON UNION fractures fail to heal by bone : Fibrous Union False joint (Pseudoarthrosis) PRELIMINARY CARE FOR PATIENTS WITH # PRIORITY 1. Airway 2. Breathing 3. Shock 4. # and dislocation Complete PE Splinting Extr # : To minimize pain Prevent further injury to the soft tissue INITIAL SPESIFIC METHODS OF TREATMENT FOR CLOSED FRACTURES 1. Protection alone(without reduction/immobilization) Indication : # costa stable, # undisplaced # stable 2. Immobilization by external splinting (without reduction) 3. Closed Reduction by manipulation followed by immobilization 4 Closed reduction bt continuous traction followed by immobilization
SPESIFIC METHODS OF TREATMENT FOR CLOSED FRACTURES 5. Closed Reduction followed by Functional Fracture Bracing 6. Closed Reduction by manipulation followed by External Skeletal Fixation 7. Closed Reduction by manipulation followed by Internal Skeletal Fixation 8. Open Reduction followed by Internal Skeletal Fixation 9. Excision of a # fragment and replacement by an Endoprosthesis CLASSIFICATION OF OPEN # TYPE I Wound < 1 cm Clean wound Bone penetrated skin with minimal injury to the muscle (usually from within) Simple #, transverse, short oblique
CLASSIFICATION OF OPEN # TYPE II: Wound > 1 cm Without extensive soft tissue damage, skin flaps or avulsion simple # transverse, short oblique,mild comminuted
CLASSIFICATION OF OPEN # TYPE III: Extensive soft tissue damage ; skin, muscle, nerve injuries and major arterial injury Often caused by high speed injury Example : Traffic accident, farm accidents Gunshot wound > 8 hours CLASSIFICATION OF OPEN # TYPE III A : High speed injury, soft tissue can coverage the wound Segmental # or severe cominutted TYPE III B : High speed injury > soft tissue loss Avulsion of periosteum Wound with severe contamination TYPE III C : Major arterial injury need to repair SPECIAL TYPES OF # Stress # (fatigue #) : March # metatarsal II-III # Prox. Tibia # jumpers and ballet dancers Pathological # : Occur in abnormal bone Without major trauma DISLOCATION Structural loss of its stability 3 structure that prevent normal ROM & also prevent joint stability
Joint shape ( joint surface )
Capsule and ligament
Muscle that prevent joint stability DISLOCATION 3 DEGREES OF JOINT INSTABILITY : 1 st Degree : Occult Joint instability ( apparent only when joint is stressed) 2 nd Degree : Subluxation ( less than luxation) 3 rd Degree : Dislocation (Luxation) ( joint surfaces have completely lost contact)
DISLOCATION Joint most susceptible to traumatic dislocation: Shoulder Elbow Hip Inter phalangeal Ankle
DIAGNOSIS Physical Examination : Swelling (edema) Deformity ( angulation, rotation, loss of normal contour, shortening) Abnormal movement Local tenderness Radiographic Examination : Typical features of a subluxation AP / LAT projection SPECIFIC TYPES OF JOINT INJURIES CONTUSION: Hemarthrosis (rupture of synovial vessels) Normal X-ray LIGAMENTOUS SPRAIN: Acute sprain, strain sudden stretching of the ligament withincomplete tears local hemorrhage local swelling tenderness, pain aggravated by movement Radiographic examination : normal Treatment : strapping / splinting DISLOCATION : Anatomical reduction immobilization
SPECIFIC FRACTURES AND JOINT INJURIES IN ADULTS Fracture less common, but more serious Weaker and less active Periosteum Less rapid fracture healing Fewer problems of Diagnosis No spontaneous correction of residual fracture deformities Differences in complication: Open fracture > common in adult Major arterial trauma Fat embolism
SPECIFIC FRACTURES AND JOINT INJURIES IN ADULTS Torn ligaments and Dislocations more common Because > rigid, child > elastic If in children make separation in adult dislocation / # dislocation Better tolerance of major blood loss Different emphasis on methods of treatment > frequently require ORIF If undisplaced # , adult tend to be more cooperative during treatment, # can be treated by protection alone
SPECIFIC FRACTURES AND DISLOCATIONS THE HAND General features: Common Treatment should always deference prevent disability Edema >> disturbance function elevation to # digits immobilized as short as possible never more than 3 weeks finger Immobilized in the flexed position
SPECIFIC FRACTURES AND DISLOCATIONS THE HAND 1. DISTAL PHALANX : Mallet Finger ( baseball finger, cricket finger ) Caused by: Passive flexion distal of the interphalangeal joint with the extensor tendon under tension may avulse a fragment of bone from the base of the distal phalanx into which the tendon is inserted. Treatment: Acute : Splinting the finger with DIP joint extended & the PIP joint flexed 3 weeks. ORIF with wire fixation. SPECIFIC FRACTURES AND DISLOCATIONS THE HAND 2. MIDDLE & PROXIMAL PHALANGES # as result of crushing / hyperextension injury Undisplaced # : Treatment: strapping to adjacent finger, Allow movement of the fingers joint(+) Usually stable displaced # : Frequently anterior angulation Treatment : ORIF if unstable 3. DISLOCATION OF THE MP. JOINTS Severe hyperextention injury Treatment : closed reduction
SPESIFIC FRACTURES AND DISLOCATIONS THE HAND 4. METACARPAL S: 1.Boxer Fracture ( Street Fighter # ): # neck metacarpal V Street fighters # Treatment : Reduction Immobilized in cast not more than 2 weeks ORIF with K-wire fixation if # unstable SPESIFIC FRACTURES AND DISLOCATIONS THE HAND
2. Bennets Fracture : # dislocation of the 1 st carpo metacarpal joint Longitudinal force along the axis of the 1 st metacarpal with the thumb in flexed Serious intraarticular fracture dislocation of the CMC joint Treatment: Closed reduction ORIF K-wire
SPESIFIC FRACTURES AND DISLOCATIONS THE HAND 3. Rolando # : # base 1 st metacarpal with intrarticular T or Y #
SPESIFIC FRACTURES AND DISLOCATIONS THE HAND 5. # SCAPHOID Relative common in young adults, particularly in males Fall on the open hand with the wrist dorsiflexed and radially deviated Clinical features: Pain on the radial side of the wrist, particularly on dorsoflexion and radial deviation Radigraphical features: Not clearly outlined in AP projection, requires special oblique projections ( scaphoid view)
SPESIFIC FRACTURES AND DISLOCATIONS THE HAND Treatment : Undisplaced immobilized in scaphoid cast Complication : Avascular necrosis Delayed union Non union Post traumatic degenerative joint disease SPESIFIC FRACTURES AND DISLOCATIONS THE WRIST AND FOREARM 1. Distal end of the Radius ( Colles # ) Colles # : # radius, 2,5 cm / 1 inch from wrist joint Commonest # in adults, > 50 th > Fracture occur through bone that has became markedly weakened by combination senile & post menopausal osteoporosis Mechanism of injury : fall with lands on outstretched hand position Clinical features: Dinner fork deformity : posterior displacement or posterior tilt of the distal radial fragment COLLES FRACTURE CLINICAL FEATURES : DINNERS FORK DEFORMITY COLLES FRACTURE Radiographic features : Stable type : There is 1 main transverse # line with little cortical comminution Unstable type : Gross comminution, particularly of the dorsal cortex, and also marked crushing of the cancellous bone COLLES FRACTURE TREATMENT : Undisplaced # : immobilization with Below Elbow Cast for 4 weeks Displaced # : Closed Reduction + BE cast Closed Reduction+ External Fixation COMPLICATION : Usually Colles # had clinical union in acceptable position within 6 weeks Preventable complication: Finger Stiffness, Shoulder stiffness, malunion Rare complication: Sudecks Reflex Symphatetic Dystrophy Late rupture EPL SPESIFIC FRACTURES AND DISLOCATIONS THE WRIST AND FOREARM 2. Reverse Colles # / Smiths # Predominantly in young men Occurs young adults Fall on the back of the flexed wrist and hence is a pronation injury Distal fragment dislocated to the anterior side
SMITHS # Treatment : Closed reduction requires strong supination of the wrist Above Elbow Cast, for 6 weeks, maintain the position in supination
SPESIFIC FRACTURES AND DISLOCATIONS THE WRIST AND FOREARM 3.Bartons # Other form of smith # Intra articular # FRACTURE OF THE SHAFT OF THE RADIUS AND ULNA RADIUS ULNA :
1. GALEAZZI # : # of the shaft of the radius and dislocation of the distal radio-ulnar joint. displaced # of distal third of the radial shaft associated with complete disruption & dislokation of the distal radioulnar joint. Usually sustained by young adults Distal fragment tilted posteriorly
FRACTURE OF THE SHAFT OF THE RADIUS AND ULNA Treatment : Open Reduction & Internal fixation of the radius, the dislocatiwill be on reduced. FRACTURE OF THE SHAFT OF THE RADIUS AND ULNA 2. PROXIMAL RADIUS # : Tend to rotate Treatment : ORIF Complication: Delayed union Non union FRACTURE OF THE SHAFT OF THE RADIUS AND ULNA 3. RADIUS ULNA # : > difficult to treat Treatment : ORIF for both bone Complication : Delayed union Non union Cross union (must avoided) FRACTURE OF THE SHAFT OF THE RADIUS AND ULNA 4. MONTEGGIA # :
# of the Prox half of the ulna accompanied by anterior dislocation of the prox radioulnar joint Dislocation post / ant Common type, hyperextension & pronation injury. Can also produced by direct trauma over the ulnar border of the forearm.
FRACTURE OF THE SHAFT OF THE RADIUS AND ULNA Treatment : Adult ORIF ELBOW AND ARM 1. # OLECRANON Commonest type is due to a fall with passive flexion of the elbow combined with powerful contraction of the triceps muscle. Treatment : ORIF using TBW (Tension Band Wire) ELBOW AND ARM 2. # OF THE RADIAL HEAD Relative common Young adults Caused by a severe valgus abduction force applied to the extended elbow Radiographic Examination: # radial head
ELBOW AND ARM Treatment : Depends upon the severity of the damage to the radial head undisplaced # : only protection, immobilized with sling for 2 weeks Depressed & comminuted # : excision of the entire head of the radius Complication : Post traumatic degenerative joint disease of the elbow
POSTERIOR DISLOCATION OF THE ELBOW MECHANISM OF INJURY : Fall on the hand with the elbow slightly flexed Severe Hyperextension injury of the elbow CLINICAL FINDING : Swollen elbow is held in a position of semi flexion Olecranon is readily palpable posteriorly RADIOGRAHIC EXAMINATION : Dislocation.
POSTERIOR DISLOCATION OF THE ELBOW TREATMENT: Closed Reduction Immobilization by cast for at least 3 weeks COMPLICATION : Elbow stiffness Median nerve injury FRACTURE DISLOCATION OF THE ELBOW Side swipe injury : Occurs when a driver has his elbow out the open window of a car at the moment the car is struck from the side by another vehicle. Usually : Elbow dislocation Multiple comminuted # of the humerus, radius & ulna Treatment : Wait until soft tissue healed ORIF FRACTURES OF THE SHAFT OF THE HUMERUS > adults Direct trauma # transverse / comminuted Indirect trauma fall on the hand # spiral Clinical Examination : Flail arm Patient tries to support with the opposite hand, Radial Nerve lesion should always be sought and its presence or absence recorded at the time of the initial examination FRACTURES OF THE SHAFT OF THE HUMERUS Treatment : Closed treatment Indication for ORIF if injury of Brachial artery which necessitates arterial repair TRANSVERSE # OF THE HUMERAL SHAFT: Anaesthesia reduction U Slab (Sugar Tong Splint) / Hanging Cast Clinical union achieved within 6 weeks
FRACTURES OF THE SHAFT OF THE HUMERUS # SPIRAL & COMMINUTED FRACTURES : Do not require reduction / anaesthesia Gravity alone is adequate to provide alignment of the fracture fragment immobilized in U shaped plaster slab
COMPLICATION : Radial Nerve Injury Delayed Union Non Union FRACTURES OF THE NECK OF THE HUMERUS In elderly persons, especially Impacted # relatively common Treatment : only protection from further injury by a sling during 6 weeks required for union SHOULDER JOINT 1. Shoulder Joint Dislocation Anterior Dislocation of the Shoulder Predominantly of young adults Caused by forced external rotation and extension of the shoulder Radiographic examination : confirm the diagnosis Treatment : Reduce as soon as possible, methods : Kocher Method Gravitation Hipocrates After reduce must immobilized by Velpeau Bandage SHOULDER JOINT 2. Recurrent Anterior Dislocation of The Shoulder : The stability of the shoulder depend on the integrity of the joint capsule capsule, capsule & anterior labrum are nearly always avulsed caused the dislocation may recur more and more frequently with less and less violence. Treatment : Surgical repair with Putti Platt operation capsule as well as the Subscapularis muscle are divided and then refeed (overlapped) limiting external rotation.
SHOULDER JOINT 3. Posterior Dislocation of the Shoulder Less common than anterior dislocation Posterior dislocation can occur : Fall on the front of the shoulder, with shoulder adducted and internally rotated Clinical Finding : The patients arm seems locked in a position of adduction and internal rotatted Radiographic finding: Not readily detected in an AP projection, need special examination : Superoinferior (axillary) projection with the shoulder abducted, is necessary to confirm that the humeral head is in fact lying posteriorly Treatment : Closed reduction SHOULDER JOINT 4. Acromioclavicular Joint Dislocation (AC Joint) Complains of severe pain over the shoulder Local tenderness (+) overthe AC joint Radiolographic examination: Patient standing and holding a weight in each hand. SHOULDER JOINT Treatment : Non operatif : Kenny-Howard Sling, depress the clavicle and elevate the acromion If failed ORIF, capsult repair, insertion of a K- wire K-wire removed after 6 weeks SHOULDER JOINT 5. FRACTURE OF CLAVICLE Common site is the middle third of the clavicle Lateral fragment pulled inferiorly and medially by the weight of the shoulder and upper limb Treatment : Figure of 8 padded bandage Clinical united in 3 weeks Complication Malunion Delayed union Nonunion relative rare FOOT 1. # OF THE METATARSAL >>common # Drop by heavy objects Run over injury with a metal wheel Important: impairment of circulation to the forefoot Treatment : multiple # K-wire fixation 4 weeks NWB walking cast worn for additional 4 weeks FOOT 2.CALCANEAL # Fall from a considerable height onto one or both heels. High incidence of associated compression # of the spine Treatment extra-artikular # : Under anaesthesia the two major fragments should manually compressed from side to side walking cast for 6 weeks intra-artikular # : ORIF FOOT 3. FRACTURES OF THE NECK OF THE TALUS
No muscle attached to talus > covered by articular cartilage Blood supply not to good # neck talus correlate with incidence of avascular necrosis (the body) and non union FOOT Mechanism of trauma Severe dorsoflexion injury as may be incurred when the driver has his foot hard on the brake pedal at the moment of a head-on collision Treatment : Closed reduction BK cast for at least 8 weeks Complication: Avascular necrosis Degenerative joint disease Nonunion
THE ANKLE # & # DISLOCATIONS OF THE ANKLE 1. Isolated # of the Medial Maleolus Abduction injury avulse medial maleolus below the joint line
Adduction injury shear off the medial maleolus above the joint line
Treatment : Undisplaced : BK cast for 8 weeks Displaced : ORIF ANKLE 2. Isolated # of the Lateral Maleolus Abduction / external rotation injury Most common injury of the ankle Treatment : Closed reduction stable immobilized in BK Cast for 6 weeks NWB 3 weeks ANKLE 3. Bimalleolar # (# of both medial & lateral malleolus) Severe injuries of the abduction or external rotation Treatment : closed reduction unstable ORIF 4. Trimalleolar # Treatment : ORIF ANKLE Complication : Joint stiffness non-union rare >> malunion sbg hsl dari loss of correction dari fragmen # Degenerative joint disease
LOWER EXTREMITY # OF THE SHAFTS TIBIA & FIBULA > fractured more frequently Periosteum is thin in adult Frequency open # Rate of union slow Mechanism of injury : Direct trauma bumper, Traffic accident Clinical features : Swelling, deformity, Tenderness Radiographic : AP / Lateral LOWER EXTREMITY Treatment Reduction of the tibia Oblique & transverse # closed reduction Clinical Union after 3-4 weeks Unstable oblique # & spiral # ORIF Complication Ankle stiffness Nerve injury Delayed union Non-union malunion
KNEE JOINT 1. # of the proximal end of theTibia ( Bumper #) Mechanism of injury : Usually in elderly A severe abduction injury, usually a direct blow on the lateral aspect of the limb with the foot fixed on the ground. Treatment: Closed reduction for elderly If the patient young ORIF
KNEE JOINT 2. Traumatic Dislocation of the knee joint Torn of 4 major ligaments : CML CLL ACL PCL Complication: Trauma of the Popliteal Artery risk of gangren in the distal part Treatment: Reduced as soon as possible Complete Dislocation of the knee joint KNEE JOINT 3. FRACTURES OF THE PATELLA Indirect : Tears of the Quadriceps expansion at the level of the patella produce transverse avulsion fracture of the patella Direct : Direct trauma comminutted Clinical finding : Patient cant extent the lower extremity Treatment : TBW
KNEE JOINT 4.INTERCONDYLAR FEMUR # Patient fall (knee in flexion position) from height. Clinical finding : swelling >> Radiolographic : Treatment : ORIF FEMUR FRACTURES OF THE FEMORAL SHAFT Clinical features: swelling >> deformity Radiographic examination : Done after ABC stabile
FEMUR Treatment: 1. Nonoperative treatment : Longer period in the hospital Longer period of weight bearing Continuous traction (12 weeks )
Clinical union active exercise, non weight bearing Radiological union
Weight bearing 2. Operative treatment : ORIF with intramedullary nail FRACTURES OF THE FEMORAL SHAFT Indication for intramedullary nail # of the femur : 1. Fail in Closed reduction 2. Multiple trauma (head trauma) 3. Femoral Artery injury need to repair. 4. Elderly, prolonged bed rest is deleterious 5. Pathological # Complication : Shock Fat embolism Knee stiffness Non-union PELVIS 1. TROCHANTERIC # OF THE FEMUR Include: Intertrochanter # ( # between the lesser and greater trochanters) # through the trochanter pertrochanteric # > common in adults over the age of 60 years > Clinical features Lower limb complete external rotation Extremity appears short Upper part of thigh is swollen PELVIS Radiolographic examination: extent of the # Treatment : ORIF Nonoperatif Complication: Malunion nonoperatif NECK FEMORAL FRACTURE 1. Subcapital 2. Transcervical 3. Basilar Garden classification : 4 type (intracapsular) Type 1 : incomplete Type 2 : complete, undisplaced Type 3 : partially displaced Type 4 : complete displaced NECK FEMORAL FRACTURE Treatment : Operative : Hemiarthroplasty for the elderly patient Complication: Avascular necrosis femoral head Non-union > 30% TRAUMATIC DISLOCATION & # DISLOCATION OF THE HIP 1. POSTERIOR DISLOCATION Position: Flexion & adduction, internal rotation Usually caused by dashboard injury Extremity became shortens
TRAUMATIC DISLOCATION & # DISLOCATION OF THE HIP Treatment: Closed Reduction Methods Complication : Avascular necrosis femoral head Sciatic nerve lesion Post traumatic degenerative joint disease
TRAUMATIC DISLOCATION & # DISLOCATION OF THE HIP 2. ANTERIOR DISLOCATION Less common Caused by a violent injury which forces the hip into extension, abduction and external rotation. Radiographical finding: head femur below the acetabulum TRAUMATIC DISLOCATION & # DISLOCATION OF THE HIP Treatment : Closed reduction as soon as possible Applying traction on the flexed thigh and then internally rotating and adducting the hip. After reduction, the patient hip should be immobilized in a Hip Spica Cast in its most stable position ( flexion, adduktion, internal rotation) TRAUMATIC DISLOCATION & # DISLOCATION OF THE HIP 1. Full flexion 2. Adduction of the hip 3. Internal rotation 4. Extension 5. Neutral position