Upload
beby-yohaningsih-hazanah
View
234
Download
0
Embed Size (px)
Citation preview
8/11/2019 Trauma musculoskeletal blok 27.ppt
1/90
MUSCULOSKELETAL
TRAUMA
Dr.dr. Nur Rachmat Lubis, SpOT.
8/11/2019 Trauma musculoskeletal blok 27.ppt
2/90
FRACTURE & DISLOCATION
FRACTURE
Definition :
A fracture, whether of a bone, an epiphysealplate or a cartilaginous joint surface, is simply a
structural break in its continuity.
must be consider :
surrounding soft tissue around the fracture
site
8/11/2019 Trauma musculoskeletal blok 27.ppt
3/90
Physical factors in the Production of Fractures
1. Cortical Bone:
can withstand compression and shearing forces better
that it can withstand tension forces
8/11/2019 Trauma musculoskeletal blok 27.ppt
4/90
2. Cancellous Bone/ spongious:
Cant withstand compression.
Can produced:
Crush # / compression #
Impacted #
8/11/2019 Trauma musculoskeletal blok 27.ppt
5/90
Descriptive Terms Pertaining to
Fractures
1. Fracture site :
Diaphyseal
Metaphyseal
Epiphyseal
8/11/2019 Trauma musculoskeletal blok 27.ppt
6/90
2. Extent of Fracture:
complete
Incomplete
8/11/2019 Trauma musculoskeletal blok 27.ppt
7/90
3. Configuration of #:
1. Transverse
2. Oblique
3. Spiral4. Comminuted
1 2 34
8/11/2019 Trauma musculoskeletal blok 27.ppt
8/90
4. Relationship of the Fracture
Fragments to Each Other :
UndisplacedDisplaced :
1. Overriding
2. Angulated
3. Rotated4. 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
8/11/2019 Trauma musculoskeletal blok 27.ppt
9/90
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 (fromwithout)
6. Complication :
Uncomplicated
Complicated:
Local : Infection
Systemic : Emboli, Sepsis
8/11/2019 Trauma musculoskeletal blok 27.ppt
10/90
THE DIAGNOSIS OF FRACTURES
HISTORY :
Fall, Direct Trauma.
Mechanism of injury.
Common symptom of # :
Localized pain.
Decreased function of the involved
part.
8/11/2019 Trauma musculoskeletal blok 27.ppt
11/90
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.
8/11/2019 Trauma musculoskeletal blok 27.ppt
12/90
THE DIAGNOSIS OF FRACTURES
!!!! CAREFULL ASSESSMENT
Patients General Condition
Search for associated injuries:Brain
Spinal Cord
Peripheral Nerves
Major vesselsThoraces
Abdominal viscera
8/11/2019 Trauma musculoskeletal blok 27.ppt
13/90
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
8/11/2019 Trauma musculoskeletal blok 27.ppt
14/90
THE NORMAL HEALING OF FRACTURES
1. Cortical bone (diaphyseal bone/ tubularbone)# 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
8/11/2019 Trauma musculoskeletal blok 27.ppt
15/90
From endosteumInternal callus
Cartilage callus change in to bone by
Endochondral Ossification
2 Clinical Union ( fracture line stillapparent)
3 Consolidation ( Radiographic Union )
4 Remodeling
8/11/2019 Trauma musculoskeletal blok 27.ppt
16/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
17/90
THE NORMAL HEALING OF FRACTURES
2. CANCELLOUS BONEInternal Fracture Hematoma
osteogenic cells from trabeculae
Internal callus
Clinical Union
Consolidation
8/11/2019 Trauma musculoskeletal blok 27.ppt
18/90
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
8/11/2019 Trauma musculoskeletal blok 27.ppt
19/90
HEALING TIME UNCOMPLICATED #
2. # Site and Configuration
# through bones that are surrounded by
muscle
>union fastercancellous bone #> union faster than
cortical bone
long oblique / spiral #> union faster thantransverse #
8/11/2019 Trauma musculoskeletal blok 27.ppt
20/90
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 goodblood supplyhealing faster
8/11/2019 Trauma musculoskeletal blok 27.ppt
21/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
22/90
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
8/11/2019 Trauma musculoskeletal blok 27.ppt
23/90
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
8/11/2019 Trauma musculoskeletal blok 27.ppt
24/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
25/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
26/90
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
8/11/2019 Trauma musculoskeletal blok 27.ppt
27/90
SPECIAL TYPES OF #Stress # (fatigue #) :
March #metatarsal II-III #
Prox. Tibia # jumpers and balletdancers
Pathological # :
Occur in abnormal bone
Without major trauma
8/11/2019 Trauma musculoskeletal blok 27.ppt
28/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
29/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
30/90
DISLOCATION
Joint most susceptible to traumatic
dislocation:
Shoulder
Elbow
Hip
Inter phalangeal
Ankle
8/11/2019 Trauma musculoskeletal blok 27.ppt
31/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
32/90
SPECIFIC TYPES OF JOINT INJURIES
CONTUSION:
Hemarthrosis (rupture of synovial vessels)
Normal X-ray
LIGAMENTOUS SPRAIN:
Acute sprain, strain
sudden stretching of theligament withincomplete tears local hemorrhage
local swellingtenderness, pain aggravated bymovement
Radiographic examination : normal
Treatment : strapping / splinting
DISLOCATION :
Anatomical reduction
immobilization
8/11/2019 Trauma musculoskeletal blok 27.ppt
33/90
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
8/11/2019 Trauma musculoskeletal blok 27.ppt
34/90
SPECIFIC FRACTURES AND JOINT
INJURIES IN ADULTS
Torn ligaments and Dislocations more commonBecause > rigid, child > elastic
If in children make separationin adultdislocation
/ # dislocation
Better tolerance of major blood loss
Different emphasis on methods of treatment> frequently require ORIF
If undisplaced # , adult tend to be more cooperativeduring treatment, # can be treated by protection alone
8/11/2019 Trauma musculoskeletal blok 27.ppt
35/90
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 possiblenever more than 3 weeks
finger Immobilized in the flexed position
SPECIFIC FRACTURES AND DISLOCATIONS
8/11/2019 Trauma musculoskeletal blok 27.ppt
36/90
SPECIFIC FRACTURES AND DISLOCATIONS
THE HAND
. DISTAL PHALANX :Mallet Finger ( baseball finger, cricket finger )
Caused by:Passive flexion distal of the interphalangeal joint with
the extensor tendon under tensionmay avulse a
fragment of bone from the base of the distal phalanx intowhich the tendon is inserted.
Treatment:Acute : Splinting the finger with DIP joint extended & the
PIP joint flexed3 weeks.
ORIF with wire fixation.
8/11/2019 Trauma musculoskeletal blok 27.ppt
37/90
SPESIFIC FRACTURES AND DISLOCATIONS
THE HAND
. METACARPAL S:
1.Boxer Fracture( StreetFighter # ):
# neck metacarpal VStreet fighters #
Treatment :
Reduction
Immobilized in cast not morethan 2 weeks
ORIF with K-wire fixation if #
unstable
8/11/2019 Trauma musculoskeletal blok 27.ppt
38/90
SPESIFIC FRACTURES AND DISLOCATIONS
THE HAND
2. Bennet
s Fracture:
# dislocation of the 1stcarpo
metacarpal joint
Longitudinal force along the axisof the 1stmetacarpal with the
thumb in flexed
Serious intraarticular fracture
dislocation of the CMC joint
Treatment:
Closed reduction
ORIF K-wire
8/11/2019 Trauma musculoskeletal blok 27.ppt
39/90
SPESIFIC FRACTURES AND DISLOCATIONS
THE HAND
3. Rolando # :
# base 1st metacarpal
with intrarticular T or Y #
8/11/2019 Trauma musculoskeletal blok 27.ppt
40/90
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 becamemarkedly weakened by combination senile & postmenopausal osteoporosis
Mechanism of injury :fall with lands on outstretched hand positionClinical features:
Dinner fork deformity : posterior displacement or posterior tilt ofthe distal radial fragment
8/11/2019 Trauma musculoskeletal blok 27.ppt
41/90
COLLES FRACTURE
CLINICAL FEATURES : DINNERS FORK DEFORMITY
8/11/2019 Trauma musculoskeletal blok 27.ppt
42/90
COLLES FRACTURE
Radiographic features :
Stable type :
There is 1 main transverse # line with little cortical
comminutionUnstable type :
Gross comminution, particularly of the dorsal cortex,
and also marked crushing of the cancellous bone
8/11/2019 Trauma musculoskeletal blok 27.ppt
43/90
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 positionwithin 6 weeks
Preventable complication:
Finger Stiffness, Shoulder stiffness, malunion
Rare complication: Sudecks Reflex Symphatetic Dystrophy
Late rupture EPL
SPESIFIC FRACTURES AND DISLOCATIONS
8/11/2019 Trauma musculoskeletal blok 27.ppt
44/90
2. Reverse Colles # /Smith
s #
Predominantly in young men
Occursyoung adultsFall on the back of the flexed
wrist and hence is a pronation
injury
Distal fragment dislocated to
the anterior side
SPESIFIC FRACTURES AND DISLOCATIONS
THE WRIST AND FOREARM
8/11/2019 Trauma musculoskeletal blok 27.ppt
45/90
SMITHS #
Treatment :
Closed reduction requires strong
supination of the wrist
Above Elbow Cast, for 6 weeks, maintainthe position in supination
8/11/2019 Trauma musculoskeletal blok 27.ppt
46/90
3.Barton
s #
Other form of smith #
Intra articular #
SPESIFIC FRACTURES AND DISLOCATIONS
THE WRIST AND FOREARM
8/11/2019 Trauma musculoskeletal blok 27.ppt
47/90
FRACTURE OF THE SHAFT OF THE
RADIUS AND ULNA
RADIUS ULNA :
1. GALEAZZI #:
# of the shaft of the radius anddislocation of the distal radio-ulnar joint.
displaced # of distal third of the radialshaft associated with completedisruption & dislokation of the distalradioulnar joint.
Usually sustained by young adults
Distal fragment tilted posteriorly
8/11/2019 Trauma musculoskeletal blok 27.ppt
48/90
FRACTURE OF THE SHAFT OF THE
RADIUS AND ULNA
Treatment:Open Reduction &
Internal fixation of the
radius, the dislocatiwill beon reduced.
8/11/2019 Trauma musculoskeletal blok 27.ppt
49/90
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.
8/11/2019 Trauma musculoskeletal blok 27.ppt
50/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
51/90
ELBOW AND ARM
1. # OLECRANON Commonest type is
due to a fall with
passive flexion of
the elbowcombined with
powerful
contraction of the
triceps muscle. Treatment:
ORIF using TBW
(Tension Band
Wire)
8/11/2019 Trauma musculoskeletal blok 27.ppt
52/90
POSTERIOR DISLOCATION OF THE ELBOW
MECHANISM OF INJURY : Fall on the hand with the
elbow slightly flexed
Severe Hyperextensioninjury of the elbow
CLINICAL FINDING : Swollen elbow is held in
a position of semi flexion
Olecranon is readily palpableposteriorly
RADIOGRAHIC EXAMINATION: Dislocation.
8/11/2019 Trauma musculoskeletal blok 27.ppt
53/90
POSTERIOR DISLOCATION OF THE ELBOW
TREATMENT:
Closed Reduction
Immobilization by cast for at least 3 weeks
COMPLICATION :
Elbow stiffness
Median nerve injury
8/11/2019 Trauma musculoskeletal blok 27.ppt
54/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
55/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
56/90
FRACTURES OF THE SHAFT OF
8/11/2019 Trauma musculoskeletal blok 27.ppt
57/90
FRACTURES OF THE SHAFT OF
THE HUMERUS
# SPIRAL & COMMINUTED FRACTURES:Do not require reduction / anaesthesiaGravity alone is adequate to provide alignment of
the fracture fragment
immobilized in U shaped plaster slab
COMPLICATION :Radial Nerve Injury
Delayed UnionNon Union
FRACTURES OF THE NECK OF
8/11/2019 Trauma musculoskeletal blok 27.ppt
58/90
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
8/11/2019 Trauma musculoskeletal blok 27.ppt
59/90
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
8/11/2019 Trauma musculoskeletal blok 27.ppt
60/90
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 mayrecur more and more frequently with less and less
violence.
Treatment :
Surgical repair with Putti Platt operationcapsule as well as
the Subscapularis muscle are divided and then refeed(overlapped) limiting external rotation.
SHOULDER JOINT
8/11/2019 Trauma musculoskeletal blok 27.ppt
61/90
SHOULDER JOINT3. 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 andinternal 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 lyingposteriorly
Treatment : Closed reduction
8/11/2019 Trauma musculoskeletal blok 27.ppt
62/90
SHOULDER JOINT
4. Acromioclavicular JointDislocation (AC Joint)
Complains of severe pain overthe shoulder
Local tenderness (+) overthe ACjoint
Radiolographic examination:
Patient standing and holding
a weight in each hand.
8/11/2019 Trauma musculoskeletal blok 27.ppt
63/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
64/90
SHOULDER JOINT
5. FRACTURE OF CLAVICLECommon 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
ComplicationMalunion
Delayed union
Nonunionrelative rare
8/11/2019 Trauma musculoskeletal blok 27.ppt
65/90
FOOT
2.CALCANEAL #
Fall from a considerable height onto one or both heels.
High incidence of associated compression # of the spine
Treatmentextra-artikular # :Under anaesthesia the two major fragments should
manually compressed from side to side
walkingcast for 6 weeks
intra-artikular # :ORIF
8/11/2019 Trauma musculoskeletal blok 27.ppt
66/90
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
8/11/2019 Trauma musculoskeletal blok 27.ppt
67/90
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 necrosisDegenerative joint disease
Nonunion
8/11/2019 Trauma musculoskeletal blok 27.ppt
68/90
THE ANKLE
# & # DISLOCATIONS OF THE ANKLE1. Isolated # of the Medial Maleolus
Abduction injuryavulse medialmaleolus below the joint line
Adduction injuryshear off themedial maleolus above the joint line
Treatment :
Undisplaced : BK cast for 8 weeks Displaced : ORIF
8/11/2019 Trauma musculoskeletal blok 27.ppt
69/90
ANKLE
2. Isolated # of the Lateral Maleolus
Abduction / external rotation injury
Most common injury of the ankle
Treatment :Closed reductionstableimmobilized
in BK Cast for 6 weeks
NWB 3 weeks
8/11/2019 Trauma musculoskeletal blok 27.ppt
70/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
71/90
ANKLE
Complication :
Joint stiffness
non-union rare
>> malunionsbg hsl dari loss of correctiondari fragmen #
Degenerative joint disease
8/11/2019 Trauma musculoskeletal blok 27.ppt
72/90
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 traumabumper, Traffic accident
Clinical features : Swelling, deformity, Tenderness
Radiographic : AP / Lateral
8/11/2019 Trauma musculoskeletal blok 27.ppt
73/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
74/90
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 thelateral aspect of the limb with the foot fixed on the ground.
Treatment: Closed reduction for elderly
If the patient young ORIF
8/11/2019 Trauma musculoskeletal blok 27.ppt
75/90
KNEE JOINT
2. Traumatic Dislocation of the knee joint Torn of 4 major ligaments :CML
CLL
ACLPCL
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
8/11/2019 Trauma musculoskeletal blok 27.ppt
76/90
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 traumacomminutted
Clinical finding :
Patient cant extent the lower extremity
Treatment :
TBW
8/11/2019 Trauma musculoskeletal blok 27.ppt
77/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
78/90
FEMUR
FRACTURES OF THE FEMORALSHAFT
Clinical features:
swelling >> deformity
Radiographic examination :
Done after ABC stabile
8/11/2019 Trauma musculoskeletal blok 27.ppt
79/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
80/90
8/11/2019 Trauma musculoskeletal blok 27.ppt
81/90
PELVIS
8/11/2019 Trauma musculoskeletal blok 27.ppt
82/90
PELVIS
Radiolographic examination:extent of the #
Treatment :
ORIF
Nonoperatif
Complication:
Malunionnonoperatif
NECK FEMORAL FRACTURE
8/11/2019 Trauma musculoskeletal blok 27.ppt
83/90
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
8/11/2019 Trauma musculoskeletal blok 27.ppt
84/90
TRAUMATIC DISLOCATION &
8/11/2019 Trauma musculoskeletal blok 27.ppt
85/90
TRAUMATIC DISLOCATION &
# DISLOCATION OF THE HIP
1. POSTERIOR DISLOCATION
Position:
Flexion & adduction, internal
rotation
Usually caused by dashboard injury
Extremity became shortens
8/11/2019 Trauma musculoskeletal blok 27.ppt
86/90
TRAUMATIC DISLOCATION &
8/11/2019 Trauma musculoskeletal blok 27.ppt
87/90
TRAUMATIC DISLOCATION &
# DISLOCATION OF THE HIP
2. ANTERIOR DISLOCATION
Less common
Caused by a violent injury
which forces the hip intoextension, abduction and
external rotation.
Radiographical finding:
head femur below the
acetabulum
TRAUMATIC DISLOCATION &
8/11/2019 Trauma musculoskeletal blok 27.ppt
88/90
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 &
8/11/2019 Trauma musculoskeletal blok 27.ppt
89/90
TRAUMATIC DISLOCATION &
# DISLOCATION OF THE HIP
1. Full flexion
2. Adduction of the hip
3. Internal rotation
4. Extension5. Neutral position
8/11/2019 Trauma musculoskeletal blok 27.ppt
90/90