Vі. A rough bottom of activity

Dislocation of a brachium.

For diaplasis вывихнутого brachiums use expedients: Kocher, Mutta-Muchina, Djanelidze, Hippocrat.

Expedient Kocher consists of 4 stages:

I - A flexion of a forearm at right angle, elongation of a brachium from top to bottom, reduction to to a thorax;

II - Peakly{Maximally} not attenuating elongation and reduction, exterior rotation of a brachium to a thorax is spent;

III - Peakly{Maximally} we translocate an elbow to top on a forward surface of a thorax;

IV - Prompt interior rotation of a brachium with reduction of a brush an able-bodied brachium.

At this moment, as a rule, the dislocation is controlled. First three stages are spent sluggishly, with an interval of 1-2 minutes. The assistant before diaplasis retains the patient for fore arm.

Expedient of Mutta-Muchina (atravmatic). The assistant the thrown towel on a back surface fore arm fixs a scapula and does contrary extension. The doctor for the incurvated forearm does elongation and abduction of a brachium, if necessary rotation and pressing by a fist a head from below.

Expedient Hippocrat. The victim lays on a back, the doctor sits down on the leg dislocation and pulls an extremity from top to bottom, simultaneously pressing a medial department of the foot in an axilla on a head, squeezing out it up and outside.

After diaplasis of a dislocation the extremity is fixed by a plaster bandage of phylum „ Dezo for ” for 4 weeks. Rehabilitational treatment includes massage, T Ph and ozocerite, electrofory.

Dislocation of a forearm.

To brake there are back, back-lateral, rarely forward, dehiscence and, isolated dislocations of a head of a radial bone. The characteristic attribute of posterior dislocations is the diverticulum of a ulnar process, at a lobby dislocations - the block of a humeral bone, disturbance equal delta circuit Gutera (at right angle a forearm we bridge vertex of a ulnar process and two process a humeral bone).

At diaplasis of a posterior dislocation the assistant pulls for brushes on a mark of a forearm, the doctor greater finders presses vertex ulnar process with contrary extension on the distal extremity of a brachium. At forward dislocations it is necessary to collect a towel of a forearm on the distal extremity of a humeral bone.

After diaplasis of a dislocation of a forearm it is recommended immobilization gypseous longett for 12-14 days.

Dislocation of a femur.

Meets less often - 4-5 % in connection with the deep locating of a head in cotyloid cavity and, the muscles educed by a load and strong ligamentum.

Behind shift of a head of a femur dislocations are parted on:

Back upper , inferior (ischial);

Lobbies: upper (pubic), inferior (obturation);

The central dislocations of a femur with fracture of a bottom cotyloid cavity.

The clinic of a dislocation of a femur depends on where the head is displaced. So, at back dislocations the flexion of an extremity in patellar and thigh joints, reduction and interior rotation of a femur is scored. At forward dislocations - abduction of an extremity, a flexion in thigh joints and patellar joints, exterior rotation of a femur. At the central dislocations a head of a femur excavation in a vacuity of a small basin through fracture of a bottom cotyloid cavity. At the survey sticking a field of a major trochanter is scored.

Diaplasis of a dislocation of a femur is spent under blanket anesthesia, if necessary with miorelacsation. There are two expedients of diaplasis of a dislocation of a femur: Djanelidze and Кохера. At diaplasis on a method Djanelidze, the patient lays on a table a gaste from top to bottom with the sinked leg. Having incurvated an anticnemion at right angle the doctor presses it from top to bottom in exterior rotation, the assistant thus fixs a basin. On method Kocher of the patient lays down on a back, the assistant fixs a basin. The doctor incurvates an extremity in patellar and thigh joints at right angle, in reduction and interior rotation pulls on an axis of a femur.

At a dislocation of a femur environmental receptacles, the central artery of a head in this connection the circulation in a head is broken are damaged, on a continuance of its recommencing the full relief of a head by 3-rd months is recommended. For prophylaxis of an aseptic necrosis of a head of a femur physiotherapeutic treatment (an ozocerite, massage, T Ph) is recommended sceletal extention 4-5 weeks, поступь by means of crutches by 3-rd months.

Dislocations of an anticnemion.

The dislocation of an anticnemion happens: back, forward, lateral. He, as a rule, is accompanied by the appreciable damage of the ligamentary apparatus, quite often articulate fractures, and also disturbances of a neurovascular fascicle and threat of development of a necrosis of an extremity.

To set a dislocation of an anticnemion it is necessary urgently, under a narcosis, without a brute force. It is necessary to check presence of recommencing of a blood flow of an anticnemion. After diaplasis of an anticnemion deep is imposed back gypseous longetta to the upper third of femur for the period of 4 weeks.

Dislocations of a kneecap happen on a phon of a dysplasia layeraly a process of a femur is more often. At diaplasis of a dislocation of a kneecap it is necessary to relax completely fourhead a muscle. Having unbent an anticnemion in a knee joint and having incurvated in thigh joint, it is carried out immobilization by a plaster bandage till 6 weeks.

Dislocations and subluxations in a joint an anticnemion-foot, as a rule, are bridged to fractures of ossicles, schin bones. There are dislocations of a foot in under talus, Shoparovis, Lisfrankas, a metatarsusfalands joints less often.

Dislocations of tinders.

To brake there is a dislocation of the first tinger. Distinguish:

● back,

● palmar,

● less often an exterior dislocation.

At the survey of a tinger its strain in the form of курка is scored. Diaplasis: pull on an axis of the basic phalanx which displace on the extremity of a head of a metacarpal bone. By uniinstantly pressing a metacarpal bone from a palm, we incurvate a dactyl in the palmar leg. After diaplasis bitwin falangs dislocations it is recommended immobilization till 10 days.

Surgical treatment of fractures.

Ordinary dislocations, the out-of-date dislocations, the complicated dislocations, some fresh dislocations (a dislocation acromial and sternaly extremity of a clavicle) and others are a subject to surgical treatment.

Final part.

This question is shined in an educational room with presence of radiological archive, X-ray patterns of all views of dislocations, their possible complications are shown, the attention to insufficiently taken up questions during employment is paid.