User talk:Litondebashishroy

Dislocation: Definition: Complete displacement of articular surface of bone of a joint is called dislocation. Or A dislocation is a total disruption of a joint with no remaining contact between the articular surfaces i.e. complete displacement of articular surfaces of joint. Subluxation: Subluxation is defined as partial loss of contact between the two ends of the bones. Or Incomplete displacement of articular surface of a joint is known as subluxation. Dislocation Commonly occurs in: •	Spine •	Upper limb: Acromino- Articular joint Sterno clavicular joint Shoulder Elbow joint Isolated dislocation of superior redio-ulner joint Wrist joint Lower Limb Hip Joint Knee joint Pattela Joint Ankle Joint Foot Fact Estability Bone configuration Soft tissue ligament, capsule and tendon Atmospheric pressure as well as gravity Classsification of dislocation: •	Etiological classification: 1.	Traumatic dislocation 2.	Pathological Dislocation a)	Septic arthritis/Tuberculous arthritis b)	Muscle paralysis 3.	Depending on time a)	Recent dislocation b)	Old dislocation Clinical features: 1.	History of trauma 2.	Pain at or near the joint. 3.	Unable to move in affected part. 4.	Deformity 5.	Swelling and later bruising at the site of injury. Treatment: Since dislocation is an orthopedic emergency early closed reduction under general anesthesia is recommended. The affected part is immobilized for a period of 3 to 6 weeks to ensure adequate healing. Operative reduction is rarely required and is reserved for 1.	Compound Dislocations 2.	Irreducible Dislocation 3.	Old unreduced dislocations 4.	Recurrent Dislocations 5.	Fracture dislocations damage Complications of dislocation: Acute complications: Injury of perineal nerves and vessels can occur,e.g. sciatic nerve palsy in posterior dislocation of hip. Chronic complications: Unreduced dislocation: This is common in asian countries due to ignorance, delay in seeking treatment etc. Recurrent dislocations: Due to inadequate and improper healing of soft tissues following initial trauma. E.g. recurrent dislocation of the shoulder. Traumatic osteoarthritis: Due to damage to the articular cartilage following impaired nutrition by the synovial fluid. Joint stiffness: Due to capsular and other soft tissue damage. A vascular necrosis: Due to injury to the vessels. Myositis ossifications: More commonly seen then in fractures due to greater periosteal strip. Commonly affected joints in dislocation: •	Shoulder Joint •	Hip Joint •	Knee joint •	Elbow joint Hip Joint Dislocation: Classification of hip joint dislocation: Traumatic dislocation: •	Posterior dislocation •	Anterior dislocation •	Fracture dislocation •	Central dislocation Pathological dislocation: •	Usually posterior dislocation Causes: Traumatic: Direct trauma- by direct hit Indirect trauma: •	Fall from height •	Road traffic accident •	During Play Pathological: •	Joint infection(septic/tuberculin) •	Rheumatoid arthritis Clinical features: •	History of trauma •	Pain & tenderness in the affected hip joint •	Swelling around the joint •	Inability to move the affected joint •	Abnormal shape •	Affected lower limb in characteristic position. E.g. In case of posterior dislocation the affected limb is adduction internally rotated and flexed of the hip joint. •	X –ray is done to confirm diagnosis. Treatment and Management: General Treatment: •	Analgesic to be given to reduce pain. Like –Inj. Diclofenac sodium •	Antibiotic Is to be given •	Sedative is to be given •	I/V fluid or Blood transfusion is to be given if necessary. •	Vitamin Supplementary is to be given. Specific Treatment: In case of recent dislocation: •	Close reduction is done under G/A followed by immobilization. •	Check x-ray is to be done to see the position of the hip joint. •	Post reduction management. In case of children: •	Hip spica for three weeks •	After three weeks hip spica is removed and physiotherapy is to be started to mobilize the affected joint and increasing the muscle strength. •	Then the patient should be allowed to walk on crutch and partial weight bearing started after 6 weeks. •	Then gradual weight bearing is to be started. In case of adults: •	Surface traction is given for 4-6 weeks. •	After 6 weeks physiotherapy is to be started to mobilize the joint & increase the muscle power. •	Then patient should be allowed to walk with crutch. •	After 8 weeks gradual weight bearing is started & the patient become normal position within 3 months. When the joint is unstable: •	Skeletal traction is given for 8 weeks to keep the joint in release position. •	After 8 weeks gradual movement of the joint is started & patient should be allowed to walk on crutch. •	After 10-12 weeks the patient is allowed to bear weight. In case of old dislocation: •	Reduction under G/A if reduction is not stable then fixation is done with pin. •	In case of children: Hip spica is to be given. •	In case of adult: Traction is given. Complications: •	Avascular necrosis •	Osteo-arthritis •	Recurrent dislocation •	Stiffness of the joint Osteoarthritis Definition: It is degenerative, non inflammatory joints disease characterized by destruction of articular cartilage and formation of new bone at the joint surfaces and margins. (John Ebenzer’s Textbook of Orthopedics” 4 th edition) It is a condition of synovial joints characterized by focal loss of articular hyaline cartilage with proliferation of new bone and remodeling of joint contour. (Davidson’s principles & Practice of Medicine ’’ 21 st edition) Pathophysiology: Fibrillation due to loss of water in weight bearing articular cartilage 	Complete loss of articular cartilage 	 Pressure on underlying bone 	Sclerosis and cyst formation in subchondural bone 	New bone formation osteophyte formation Causes: 	Trauma around the joint 	Old age people 	Irregularity of the joint surface 	Congenital mal-development 	Obesity and over weight Clinical features: 	H/O trauma 	Pain in the affected joint 	Joint stiffness 	Swelling 	Restricted movement of the joint 	Crepitating during joint movement 	Deformity 	Redness may be present 	X-ray finding x-ray shows irregularities on joint surface and presence of osteophytes Types: 	Primary osteoarthritis-without cause 	Secondary osteoarthritis-Predisposing abnormality in the joint,ligament,tendon etc. 1.	Post traumatic 2.	Congenital abnormality in the bone and joint.e.g. Congenital hip dislocation. 3.	Inflammatory- Secondary to septic arthritis ,gout,rheumatoid arthritis etc Investigations: 	Blood for TC,DC,ESR,HB% usually normal 	X-ray of the affected joint is the most important investigation. Treatment and Nursing management of osteoarthritis: •	Keep the patient rest in bed •	Painful joint should be kept in functional position •	Reassurance the patient •	Pillow should not be used under the painful joint •	Instruct the patient for restricted walking •	Encourage and assist the patient during use of crutch. •	Apply heat locally to strengthen muscles and associated joints. •	Encourage patient for slowly exercise. •	Analgesic- Anti-Inflammatory drugs is to be given to relieve pain like- Diclofenac sodium. •	When above treatment is failed then surgery is needed- osteotomy or joint replacement. •	Care must be taken in bony prominence area to prevent pressure sore. •	Check and record pulse,temperature,respiration and BP. •	Encourage and assist the patient during sitting ,eating,and drinking. •	Assist the patient during bed panning and to pass urine. •	Diet- An adequate diet is to be given. Definition of orthopedics: