Dislocation

Fajar Prabowo

Definition
Dislocation means that the joint surface are completely displaced and are no longer in contact. Subluxation implies a lesser degree of displacement such that the articular surface are still partly apposed.

Anatomy
Joint is a union or junction between two or more bones or rigid parts of the skleton. Classification of joints : 1. The articulating bones of synovial joints are unite by a joint (articular)capsule (composed of an outer fibrous layer of membrane lined by a serous synovial membrane) spanning and enclosing an articular cavity. 2. The articulating bones of fibrous joints are united by fibrous tissue. (ex ; suture of the cranium) 3. The articulating structures of cartilaginous joints are united by hyaline cartilage or fibrocartilage. (ex; symphyses, intravertebral discus)

Type of Synovial Joints

The six major type of synovial joints : 1. Plane joints (ex; acromioclavicular joints) 2. Hinge joints (ex; elbow joints) 3. Saddle joints (ex; carpometacarpal joints) 4. Condyloid joints (ex; metacarpophalangeal joints) 5. Ball and socket joint (ex; hip joint) 6. Pivot joints (ex; atlantoaxial joint)

Physiology
(Normal Joints Stability)

Synovial joints are designed to permit smooth movement through a normal range that is spesific for each joint.

 Three degrees of joint instability :

1. Occult joint instability (apparent only when the joint stressed) 2. Subluxation 3. Dislocation
when the dislocation is accompanied by either an intra-articular or extra-articular fracture, its referred to as a fracture-dislocation

Fracture-dislocation

Location of Dislocation
Most susceptible to traumatic dislocation are the shoulder, elbow, interphalangeal, hip and angkle joint.

Dislocation in shoulder

Dislocation of the elbow

Diagnosis of Joint Injuries

(Dislocation)

History Mechanism of injury Following an injury the joints is painful and the patient tries at all costs to avoid moving. Muscle spasm Decrease function

Physical examination
LOOK Swelling(unless the dislocated joint is deep) Deformity(angulation, rotation) Abnormal movement(occuring through the unstable joint) FEEL Local tenderness

Radiographic
X-Ray ( two position: AP & L)

Treatment
To restore normal congruity to the joint surfaces, perfect reduction of dislocation and subluxations must be achieved, eiher by closed manipulation or when necessary by open reduction The dislocation must be reduced as soon as possible, usually a general anaesthetic is required and muscle relaxant. After reduction of the dislocation, consideration must be given to the torn ligaments to prevent the complication of residual joint instability and resultant recurrent dislocation of the joint.

Normal Healing of Ligament

Unlike bone, which heals without a scar, torn ligaments heal by fibrous scar tissue that is not as strong as the normal ligament. The time required for normal healing of a torn ligament varies according to its size and force to which it is normally subjected( ligament of the finger joint 3 weeks and ligament of the knee 3 months) The joints is immobilized until soft tissue healing accurs usually after 3-4 weeks

Dislocation of the knee

Complication
Immediate local complication Injury to skin, blood vessel, peripheral nerve Early local complications Infection Avascular necrosis Late complications Persistent joint stiffness Persistent joint instability Recurrent dislocation Post-traumatic arthritisa(degenerative joint disease)