➤➤Improved chair back reduction method
Modified chair back reduction method, using shoulder joint reducer to assist reduction. During reduction, the patient is sitting in a sitting position, generally, without anesthesia, the axilla of the affected limb is abducted and placed on the reducer (the height of the reducer can be adjusted according to the height of the patient), and the elbow joint is straightened, the forearm is fully supinated, and the operator is 40° from the ground along the axis of the forearm. For angular traction, the force gradually increases, and at the same time, the upper arm can be retracted to increase the leverage of the reducer, and the assistant can hold the reducer placed on the back of the chair to give counter traction (Figure 1). After successful reduction, Dugas's position (Figure 2) was given for 2 weeks of fixation.
Figure 1 Schematic diagram of the chair back reduction method for shoulder dislocation
Figure 2 External image of shoulder joint dislocation after reduction and fixation
The shoulder joint reducer (Fig. 3) can be placed on the back of the chair. The width of the soft arch is about 5-8 cm, and the height is adjustable.
Figure 3 Shoulder joint reducer
Hand-pulling and pedaling method: The patient lies on the bed, and the surgeon faces the patient, either sitting or standing. Extend one foot under the patient's armpit, hold the patient's forearm with both hands, and continue traction. Do not interrupt the traction and gradually increase the traction until the patient's shoulder muscles relax and the shoulder will automatically reset.
Anesthesia is generally not required unless the patient has extremely strong shoulder muscles and has been dislocated for more than 3 to 4 days and requires anesthesia (intravenous or high brachial plexus block). The key lies in patient traction, which can generally be successfully reset. (Figure 4)
Figure 4 Schematic diagram of the reduction of shoulder dislocation
Elbow dislocation
Later dislocation of the elbow joint is more common (with posterolateral or posteromedial dislocation).
When the patient is in a supine position during manual reduction, anesthesia is generally not required. Two assistants hold the upper arm and forearm of the patient respectively to resist traction. The surgeon should first correct the lateral displacement (if the front and rear displacement is corrected first, the reduction may fail). Generally, Lateral displacement is mainly to the radial side. The surgeon presses the radial head with the thumbs of both hands and holds the elbow of the affected limb with the remaining hands and four fingers to push the radial head to the ulnar side. When the lateral displacement is corrected There was a clear sense of recollection (Figure 5).
Figure 5 Schematic diagram of lateral displacement of elbow joint dislocation correction
Reduction of posterior elbow dislocation: two assistants hold the patient's upper arm and wrist respectively to resist traction, the operator squatting halfway, two thumbs against the olecranon of the ulna, and the remaining four fingers are held on the distal humerus of the elbow. Gradually flex the forearm with distal traction to reduce the elbow joint (Figure 6). Anterior elbow dislocation reduction manipulation is the opposite. After successful manual reduction, the elbow joint was flexed 90° and fixed for 4 weeks before functional exercise.
Figure 6 Schematic diagram of displacement after correction of elbow dislocation
subluxation of the radial head
It is more common in children aged 1 to 4 years because the ligaments, muscles, and bones of the elbow joint of children are not fully developed, and the joint capsule is relatively loose. When the elbow is stretched, the negative pressure in the elbow joint increases, and the loose anterior joint capsule The annular ligament and the annular ligament are sucked into the joint cavity and embedded between the radial head and the capitellum of the humerus, and the radial head is displaced radially, forming a subluxation.
Clinical manifestations and diagnosis: There is a history of being pulled by others, elbow pain, the child refuses to use the affected limb to take objects, and keeps it in the semi-flexion position. The forearm is in pronation. There was no obvious swelling of the elbow, and there was no obvious change in the X-ray examination.
Treatment generally does not require anesthesia, and manual reduction is sufficient. The surgeon compresses the radial head with the thumb in one hand and the affected hand with the other hand, supinations the forearm (pressing the radial head and forearm supination simultaneously), flexes the elbow joint and can feel or hear a slight popping sound during reduction. The pain disappeared immediately and the elbow function recovered (Fig. 7).
Figure 7 Schematic diagram of reduction of radial head subluxation
hip dislocation
Hip dislocation is mostly caused by direct violence, usually posterior dislocation, occasionally anterior dislocation, and central dislocation. Posterior dislocation, and anterior dislocation can also be associated with acetabular fractures.
The hip joint is structurally stable and strong external forces are required to cause dislocation. Most of the patients were young adults with high activity intensity. Generally divided into anterior, posterior, and central dislocation 3 types. An anterior dislocation occurs when the femoral head is located before the line of Nelaton (the line connecting the anterior superior iliac spine and the ischial tubercle).
Dislocations located behind this line are posterior dislocations. The femoral head is squeezed toward the midline, breaking through the acetabulum and entering the pelvis as a central dislocation. Of the three types, posterior dislocation (Fig. 8) is the most common. This injury should be treated as an emergency, and the earlier the reduction, the better the effect.
Figure 8 X-ray film of posterior dislocation of the hip joint
Treatment of posterior hip dislocation: the patient is supine, the assistant presses down the front of the iliac crest to fix the pelvis, the surgeon flexes the affected hip and knee to 90° to relax the iliofemoral ligament and knee flexor, and the surgeon puts the elbow Continue longitudinal traction on the thigh behind the patient's knee joint (Figure 9) for several minutes and gently rotate the affected limb, and the hip joint can be reduced.
When encountering resistance during the reduction process, patience and continuous traction should be used, and violence should not be used, especially for older patients to prevent complications.
Figure 9 Schematic diagram of hip dislocation reduction
sacroiliac joint dislocation
The sacroiliac joint is composed of the ear-like articular surfaces of the sacrum and the ilium, which are uneven and intercalated ear-like articular surfaces. The joint capsule is tense and wrapped by many strong ligaments. The joints of the lower extremities that transmit weight and support and the dislocation of the sacroiliac joints are all caused by violence (such as falling from a height) accompanied by separation of the pubic symphysis or fracture of the pubic bone.
Clinical symptoms: unequal length of both lower extremities. Bilateral sacroiliac joint X-ray films can confirm the diagnosis.
Manual reduction: The patient is in a supine position under spinal anesthesia. A soft barrier is placed on the perineum to facilitate resistance to traction during reduction. The assistant holds the ankle of the affected limb with both hands, and gradually increases the force and traction along the neutral position of the ankle. The surgeon stands on the side of the affected limb, facing the foot, presses both palms on the upper and rear sides of the iliac crest, and cooperates with the assistant to increase the force. When the iliac wing is suddenly pushed in the direction of the foot, the echo sound can be heard (Fig. 10). When measuring the equal length of both lower limbs, the reduction is successful.
X-rays are required to confirm. After reduction, the affected limb was maintained with skin traction for 1 to 2 weeks. 6 weeks after reduction, you can get out of bed with crutches and walk.
Figure 10 Schematic diagram of sacroiliac joint dislocation reduction
dislocation of temporomandibular joint
Temporomandibular joint dislocation is caused by the continuous contraction of the lateral pterygoid muscle and the reflex contracture of the obturator muscle group when the patient opens his mouth wide, such as yawning, singing, or biting hard food. Return to the original position.
Dislocations are mostly unilateral, and clinically common cases are acute anterior dislocation and recurrent anterior dislocation. If the acute joint dislocation is not treated in a timely manner, it can be complicated by a joint disc injury, joint capsule, and joint ligament tissue relaxation, resulting in recurrent joint dislocation.
Extraoral reduction method: the patient is sitting, the operator stands opposite the patient, first gently massage the mandibular joint and masticatory muscles with both palms or fingers for 3 to 5 minutes to relax the local muscles, and asks the patient to slowly tilt the head back or When the operator uses both hands to assist the head to slowly tilt back about 45°, the depressor muscle group naturally pulls the mandible downward, and the contracture of the obturator muscle group is relieved at the same time. The condyle can be reduced by pushing the condyle downward and posteriorly with a little force (Figure 11).
Figure 11 Schematic diagram of temporomandibular joint dislocation reduction
For those who are difficult to reduce at the same time on both sides, it can be divided into two sides. After repositioning, the patients were instructed to prohibit large mouth opening within 1 to 2 weeks and to limit mandibular movement for 2 to 3 weeks. Habitual dislocation can be fixed with Cranio-maxillary bandages or elastic bandages.
