Management Of Posterior Dislocation

CLINICAL EXAMINATION i. Position- The affected limb is supported by the normal hand. There is obvious deformity around the elbow-joint because of the undue prominence of the olecranon process. The joint is maintained in a semi-flexed position. ii. Obliteration of the triangular relation- Three points joining the olecranon process, medial and lateral epicondyles do not establish the ipsilateral triangular relation. iii. Check for neurovascular symptom- Sensory and motor functions of the medial ulnar and radial nerves are tested. The colour, temperature of the forearm and radial pulsation must be checked. X-ray: The temptation to reduce the dislocation without prior x-ray investigation can prove dangerous. Dislocation of the elbow-joint may be associated with fracture of the coronoid process, olecranon process, head of the radius, medial and lateral epicondyles. Reduction without prior x-ray investigation is likely to miss the associated bony injuries. TECHNIQUE OF REDUCTION General anaesthesia: Reduction is done under general anaesthesia and with the use of muscle relaxants. Traction: The surgeon applies traction by holding the forearm with both hands while counter-traction is applied by the assistant grasping the arm. Traction and Flexion: While traction is maintained the surgeon applies pressure on the forearm just distal to the elbow-joint thereby helping the ulna to glide forward on the trochlear notch of humerus. Splintage: A dorsal splint is applied extending from below the axilla to the head of the metacarpal bones with the forearm in mid-position. Immobilization is maintained for a period of 3 weeks. Active exercise is allowed following removal of the splint. ANTERIOR DISLOCATION OF THE ELBOW-JOINT The technique to reduce the anterior dislocation of the elbow-joint is done on the same principle as that of posterior dislocation. Reduction: This is done under general anaesthesia in stages. 1. Traction: Traction and counter-traction are applied to the elbow-joint. 2. Posterior pressure: While the traction is maintained the elbow is slightly flexed. The forearm bones are then pushed posteriorly. This enables the olecranon process to glide posteriorly over the humerus to its normal position. Immobilization: This is maintained in the same way as in the case of posterior dislocation. Graduated exercise is performed at the end of immobilization. MANAGEMENT OF THE ASSOCIATED FRACTURES I. DISLOCATION WITH FRACTURE OF THE CORONOID PROCESS Fracture of the coronoid process is likely to happen along with posterior dislocation of the elbow-joint. When the fracture is reduced, the fractured surface naturally becomes aligned to its normal position. The elbow-joint is immobilized in a long arm plaster with the joint flexed at an angle of more than 90⁰. The plaster is removed after a period of 4 weeks. II. ASSOCIATED FRACTURE OF THE OLECRANON PROCESS Fracture of the olecranon process is usually associated with anterior dislocation. (a) Internal fixation: The best method is to perform internal fixation for fracture of the olecranon process after the reduction of the dislocation is done. Surgeon use orthopedic bone screws to attach implant like as Bone Plates, Locking Plates etc. (b) Immobilization in extension: In selected cases immobilization of the joint in extension following reduction of the dislocation may be a suitable method when fracture of the olecranon process is an accompanying feature. III. ASSOCIATED FRACTURE OF THE HEAD OF RADIUS Once the dislocation is reduced the head of the radius is exercised after a period of 3 weeks. Immediate excision following reduction can also be performed. For treatment surgeons and doctors use best quality of orthopedic implants and instruments, which are provided by orthopedic implant importer or manufacturers. Siora Surgicals Private Limited makes easy to available orthopedic Implants in Indonesia.