Treatment method of elbow joint dislocation.
The elbow joint is one of the more stable joints of the human body, and elbow joint dislocation is a common injury of the elbow. Its incidence accounts for about half of the dislocations of hip, knee, shoulder, and elbow joints, and it is more common in adolescents. If the dislocation can be diagnosed early and correctly and effectively treated, it can usually be completely recovered. If it is not effectively treated early, some dysfunction is often left. Since dislocation of the elbow joint is often accompanied by other structural damage to the elbow, it should be carefully checked during diagnosis and treatment.
Posterior dislocation of elbow
Injury mechanism: The most common type of posterior dislocation of the elbow joint is more common in adolescents. The posterior dislocation is often caused by the palm of the hand falling, the elbow is slightly overextended, and the external force is transmitted to the straightened elbow after the fall. If the elbow joint is in the overextended position, the collateral ligament and joint capsule are also torn, the ulna olecranon shifts backward, and the lower end of the humerus shifts forward, causing a posterior dislocation of the elbow joint.
Diagnosis: It can be diagnosed according to the mechanism leading to the dislocation of the elbow joint and the X-ray lateral radiograph. Care should be taken to observe the X-ray lateral radiograph of the elbow joint to exclude distal humeral fractures, radial head fractures, and coronoid fractures.
Treatment: Blood vessels and nerve damage should be excluded before manual reduction. A common vascular injury is a brachial artery injury. The disappearance of the arterial pulse does not prevent manual reduction, if the arterial pulse is not touched after the reduction. Arterial exploration and reconstruction should be performed immediately. Nerve injury manifests as innervated muscle movement and skin sensation disappeared, and surgical exploration should be performed immediately.
Closed reduction: the short time after injury can not be compared to anesthesia, and the brachial plexus anesthesia should be given to those who are more than 4 hours. Taking the right elbow joint as an example, the elbow flexion is 60 ° ~ 90 °. The assistant clasps the patient's upper arm with both hands. The surgeon holds the wrist with both hands and continues to traction. At that time, it returns to success. After reduction, the upper extremity plaster or elbow brace is fixed in the functional position. Remove it after 3 ~ 4 weeks, and gradually start active functional exercise. It is not appropriate to do vigorous exercise during this period.
Open reduction: Acute elbow dislocation rarely requires open reduction. If a fracture is embedded in the joint space, closed reduction fails, open reduction is feasible.
Prognosis: Simple elbow dislocation generally has a good prognosis, and it can return to the healthy side's range of activity 3 to 4 months after effective treatment. With the complex dislocation of fractures, healing often leaves some functional limitations.
Anterior dislocation of elbow
Injury mechanism: Simple anterior dislocation of the elbow joint is relatively rare, often combined with olecranon fractures. The reason is that the elbow flexion impact or violence directly acts on the forearm after a fall, resulting in fracture of the ulna olecranon and dislocation of the ulna forward. Generally, the external force causing anterior dislocation is severe, and the degree of soft tissue injury is serious, often accompanied by vascular nerve injury. If combined with brachial artery injury, vascular nerve function should be carefully evaluated.
Treatment: Basic maneuver reduction is an anti-injury mechanism, which fights muscle spasm under traction, and then exerts backward and downward pressure on the forearm while squeezing the front end of the humerus forward to complete the reduction. After the reset, the functional position of the plaster or elbow brace is fixed, and the same position is dislocated.
Lateral dislocation of elbow
Injury mechanism: The lateral dislocation of the elbow joint is divided into medial and lateral dislocation. The lateral dislocation is caused by the elbow valgus violence, and the medial dislocation is caused by the elbow varus violence. The lateral collateral ligament and the joint capsule opposite to the direction of the dislocation are seriously injured, but the dislocation The damage on the side is lighter.
Treatment: Reset, the upper arm is taken against traction, the elbow is slightly extended, and then the inner or outer side of the elbow is directly pressed. The medial elbow dislocation is often subluxation, and the soft tissue injury is not as good as external dislocation.
Radial head subluxation
Subluxation of the radial head, also known as pulling the elbow, is a common injury in children. The disease is more common in children 1 to 3 years old, and it is rare after 5 years old, of which 2 to 3 years old is the most common. More than the child's elbow joint was straightened when the forearm was protruded, and the prognosis was good.
Diagnosis: The child has a history of crying suddenly after being pulled by the elbow. The affected limb is in the semi-flexed pronation position. He is unwilling to move the affected limb and is not willing to take the object. Passive elbow flexion and forearm rotation are painful, and the elbow There was no obvious swelling, and there was mild tenderness at the radial head. X-ray examination is negative.
Reset: Manipulative reset is more successful, there is a sound during reset, the child immediately stops crying, and can use the affected limb to take things.
Fixation: No special fixation is needed, just hang the affected limb for a week.