Diskusi Topik Dr. Kholis

8/19/2019 Diskusi Topik Dr. Kholis

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2/29

De%ni&ion

• I& is com$le&e an $ersis&en&is$lacemen& o' a (oin& in which a&leas& $ar& o' &he su$$or&ing (oin&ca$sule an some o' i&s ligamen&sare isru$&e!


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T)$es o' isloca&ion

• Congenital• Acquired

1! Trauma&ic

*! Pa&hological e!g! T+ hi$# Se$&icAr&hri&is

,! Paral)&ic e!g! Poliom)eli&is# cerebral

$als)# e&c-! In.amma&or) isorers# rheuma&oi

ar&hri&is#e&c


4/29

Disloca&ion

• "os& commonl) occur in &he'ollowing (oin&s!

• Shouler

• /i$

• lbow

• "e&acar$o$halengeal (oin&

• ace& (oin& isloca&ion in cer2ical s$ine!

• Acromicla2icular (oin& isloca&ion!


5/29

DISLOCATION SI3NS

• 4isibl) ou&5o'5$lace# iscolore# ormissha$en (oin&

• Limi&e (oin& mo2emen&

• Swollen or bruise

• In&ensel) $ain'ul# es$eciall) i' )ou &r)&o use &he (oin& or bear weigh& on i&

or mo2e i&!• Decrease sensa&ion is&al &o &he (oin&

• Decrease $ulse# cool e6&remi&)


6/29

T)$ical e'ormi&ies in isloca&ion

• Shouler5 abuc&ion e'ormi&ies• lbow5 .e6ion e'ormi&ies

• /i$:

An&erior5 .e6ion abuc&ion an in&ernalro&a&ion e'ormi&ies!

Pos&erior5.e6ion# auc&ion an in&ernalro&a&ion e'ormi&)

• Knee5.e6ion e'ormi&)• An7le52arus e'ormi&)


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In2es&iga&ions

• 8aiogra$h o' &he a9ec&e $ar&shoul inclue an&erior $os&erior anla&eral 2iews an some&imes s$ecial

2iews neee!


8/29

Princi$les o' managemen&

• Acu&e isloca&ion shoul be reuceas soon as $ossible!

• O$en reuc&ion is rarel) necessar)'or acu&e isloca&ion!

• Close reuc&ion wi&h in&ra2enousanalgesia an sea&ion or uner 3Ashoul be a&&em$&e %rs& 'or mos&uncom$lica&e isloca&ion!


9/29

8IC

• 8 5 8es&

•

I 5 Immobilie• C 5 Col

• 5 le2a&e


10/29

8emember in Disloca&ion

• I& is an or&ho$eic emergenc)!

• 8euc&ion shoul be ;uic7 an$rom$&!

• 8euc&ion shoul alwa)s be uner3


11/29

8emember in Disloca&ion

• Close reuc&ion is su=cien& in mos&o' &he &imes!

• O$en reuc&ion is res&ore &o i's$eci%call) inica&e!

• 8euc&ion &echni;ues shoul alwa)sbe 2er) gen&le!

• Pain will no& subsie b) s$lin&ingunli7e 'rac&ures!


12/29

Shouler Disloca&ion

• T)$es:

• An&erior isloca&ion: 4ari&ies o'isloca&ions li7e Subcoracoi#subglenoi# sub5in'racla2icular#in'erior!

• Pos&erior Disloca&ion


13/29

8aiological ImagesAn&erior Disloca&ion


14/29

8aiological ImagesAn&erior isloca&ion

• Occurs wi&h &he

arm hel inabuc&ion ane6&ernal ro&a&ion!


15/29

8aiological ImagesPos&erior Disloca&ion

• Causes

1! $ile$s)

*! lec&rocu&ion


16/29

8euc&ion Techni;ues

• Stimson’s Gravity Method


17/29

8euc&ion Techni;ues

KOCHER’s Method


18/29

8euc&ion Techni;ues


19/29

A'&er Trea&men&

• The arm shoul be 'as&en &o &heches& wi&h a bo) banage minimum$erio o' &hree wee7s!


20/29

/i$ Disloca&ion

T)$es:

A! Pos&eriorDisloca&ion

+! An&erior

Disloca&ionC! Cen&er Disloca&ion


21/29

"echanism o' Disloca&ion


22/29

/i$ Disloca&ion

• Clinical ea&ures:

o /


23/29

8aiological Images/i$ isloca&ion


24/29

/i$ Disloca&ion8euc&ion &echni;ues

• The $a&ien& issu$ine on &he .ooruner 3A!

• The hi$ is .e6e &o>0 egree!

• Assis&an&s&abiliing &he

$el2is!

• Longi&uinal&rac&ion is a$$lie!


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26/29

lbow Disloca&ion

• Commonl) ue &o'all on ou&s&re&chehan!

• Closed reductionand long arm bac

slab 'or , w7s is&he &rea&men& o'

choice!


27/29

"P @oin& Disloca&ion


28/29

IP Disloca&ion

• 8euc&ion Techni;ues!!


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T8I"A KASI/

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Diskusi Topik Dr. Kholis