Bs CKI.CTCH.

Trần Văn Thuyên

Trưởng Khoa CTCH
Phone:0983969491
Mail: thuyentranvan@gmail.com
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 1. If anatomical, concentric reduction cannot be achieved by
gentle, closed techniques with the patient under general
anesthesia. Interposed soft tissues or osteochondral
fragments may contribute to the irreducibility.
 2. If a stable reduction cannot be maintained. Articular
fractures often are unstable and must be reduced and fixed to
ensure stability of the reduction.
 3. If careful evaluation before closed reduction reveals norma
neurological function and, after reduction, a definite,
complete motor and sensory nerve deficit becomes evident.
 4. If circulatory impairment distal to the injury is well
documented before reduction and persists after reduction.
Further assessment of the circulation is essential and should
include arteriography.
 5. If ischemia is persistent. Surgical exploration with
appropriate management of the vascular injury is indicated.
 .
 Shoulder
Dislocation
Posterior

Rare 2-4% of shoulder dislocations

Arm locked overhead 110-160
deg abduction, hand resting on
head
AP radiograph: spine parallel to
humerus
Arm held across chest
Adducted
Internally rotated
Flat and squared off
 The hip joint is inherently stable, and hip
dislocations generally are produced by high-
energy trauma
 Posterior dislocations occur much more
frequently than anterior dislocations
 posterior hip dislocation present with hip flexion,
adduction, internal rotation, and a shortened
extremity
 Anterior dislocations cause the leg to be held in a
position of abduction and external rotation
 Several methods of closed reduction have been
used successfully, all of which generally
consist of recreating the injurious deforming
force :
+ for posterior dislocations—flexion, adduction,
and internal rotation;
+ for anterior dislocations—abduction and
external rotation in extension).
Traction in line with the affected femur and small
amounts of rotation and abduction and
adduction complete the reduction
 Sciatic nerve palsy complicates simple
posterior hip dislocation in 13% of patients.
No neurological sequelae have been reported
after anterior hip dislocation
 acromioclavicular ligament
Neither is
acromioclavicular nor disrupted, and
coracoclavicular coracoclavicular ligament is
ligaments are intact
disrupted

ligaments are disrupted,

and
distal end of clavicle is
displaced posteriorly
into or through tra-
both ligaments are pezius muscle
disrupted.
ligaments and muscle attachments ligaments are disrupted, and distal
are clavicle is dislocated infe-rior to
disrupted, and clavicle and coracoid process and posterior to
acromion are widely separated biceps and coracobra-chialis tendons
Without weights

With weights
 Nonsurgical treatment by strapping, bracing,
or splinting
 Conservative treatment fails chiefly because
of the interposition of the articular disc,
frayed capsular ligaments, and fragments of
articular cartilage between the acromion and
the clavicle.
 (1) skin pressure and ulceration,
 (2) recurrence of deformity,
 (3) necessity of wearing the sling or brace for 8
weeks,
 (4) poor patient cooperation,
 (5) interference with activities of daily living,
 (6) loss of shoulder and elbow motion (in older
patients),
 (7) soft tissue calcification,
 (8) late acromioclavicular arthritis, and
 (9) late muscle atrophy, weakness, and fatigue.
 1) infection,
 (2) anesthetic risk,
 (3) hematoma formation,
 (4) scar formation,
 (5) recurrence of deformity,
 (6) metal breakage, migration, and loosening,
 (7) breakage or loosening of sutures,
 (8) erosion or fracture of the distal clavicle,
 (9) postoperative pain and limitation of motion,
 (10) second procedure required for removal of
fixation,
 (11) late acromioclavicular arthritis, and
 (12) soft tissue calcification (usually insignificant)
 (1) acromioclavicular reduction and fixation; (2)
acromioclavicular reduction, coracoclavicular
ligament repair, and coracoclavicular fixation;
 (3) a combination of the first two categories;
 (4) distal clavicle excision; and
 (5) muscle transfers.
 Any surgical procedure for acromioclavicular
dislocation should fulfill three requirements:
 (1) the acromioclavicular joint must be exposed
and débrided;
 (2) the coracoclavicular and acromioclavicular
ligaments must be repaired or reconstructed; and
 (3) stable reduction of the acromioclavicular
joint must be obtained.
Volar lunate dislocation
Stage I
Volar perilunate
dislocation
Dorsal perilunate dislocation
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