RU2364378C1 - Shoulder diaplasis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics and can be applied in shoulder diaplasis. A patient with outstretched legs is seated leaning against a movable support fixed after the patient's sizes. A flexible rod is delivered in axillary region with dislocating the proximal shoulder in a slip-opposed direction. Simultaneously the shoulder is extended along the longitudinal axis with holding forearm bent at the right angle. Slight rotations are performed to set the humeral head in glenoid cavity.

EFFECT: method allows reducing diaplasis-associated injuries.

2 ex

Description

The invention relates to medicine, namely to traumatology and orthopedics, and can be used in the treatment of shoulder dislocation.

Known methods for closed reduction of shoulder dislocation (see A.F. Krasnov, RB Akhmedzyanov. Shoulder dislocations. M: Medicine, 1982, p. 61-79), in which or use a backstop in the form of a cloth strap (Kocher method , Zaichenko, Mukhin, Cooper II, Angers, etc.), which does not allow rigid fixation of the scapula, or, when repositioned, make significant muscular efforts (the method of Cooper, Volkov, Richet, Meshkov, Mays, etc.), which lead to uncoordinated actions and excessive tissue trauma. In these methods, medical anesthesia is mandatory and there is no indication of the method of reduction if it is impossible to carry out it (for example, individual drug intolerance, extreme situations when it is not possible to anesthetize, etc.)

There is a method of repositioning a shoulder dislocation (see AS USSR No. 1156670), in which a support pillow is placed in the axillary region, the shoulder is stretched along the longitudinal axis, and the head of the shoulder is introduced into the joint cavity by rotational movements of the forearm.

The disadvantage of this method is that the blade remains movable and its rigid fixation in the extremely upper position (cranial) is impossible. When adjusting a dislocation, the operator is forced to spend considerable muscular energy and time, first, on displacement and fixation of the scapula in the extremely upper position (in order to tighten the muscles around the scapula and stabilize it), and then on the actual direction of the head into the articular cavity, which leads to an increase in the trauma of repositioning .

The closest technical solution is the method of adjusting the dislocation of the shoulder, in which the patient under the axillary region rests on the movable support, which at the moment of setting moves cranially, dragging the shoulder blade along with the upper limb, and rigidly fixes it in the reached position. By simultaneous extension of the shoulder along the longitudinal axis and subsequent rotational movements in the shoulder joint against the background of postisometric muscle relaxation, the dislocation is repaired (RU 2066157, IPC 6 A61F 5/042).

However, this method is also traumatic and unsafe, since with a cranial movement of the axillary region at the time of reduction it is impossible to accurately calculate the strength and magnitude of the movement, therefore, it is possible to injure large vessels located in the axillary cavity, as well as cartilage or bone tissue, as evidenced by the sound clicks when setting.

The technical result of the claimed invention is to reduce the morbidity.

This result is achieved in that when the dislocation of the shoulder is corrected by focusing the patient’s axillary region on a movable support, muscle relaxation, shoulder extension along the longitudinal axis caudally, followed by rotational movement in the shoulder joint, characterized in that the emphasis is made on a movable support made with the possibility of fixation , muscle relaxation is performed in the patient’s position with legs extended and focusing on a support fixed in accordance with the patient’s size, after which flexible traction is introduced into the axillary region and keeping the proximal humerus in the direction opposite to the dislocation, the shoulder while pulling along the longitudinal axis of the bent at right angles to the forearm, and making easy rotary motion, produces reduction of the humeral head in the glenoid cavity.

From the existing sources of literature such a method is not known, therefore, we can conclude that the technical solution of the criterion of “novelty” is consistent, and the distinguishing features can be attributed to significant distinguishing ones, since such features are also not known.

The method is as follows. First, complete anesthesia of the shoulder joint. The direction of the shoulder dislocation is performed on a special chair to reposition the shoulder dislocation, the back of which is made in the form of a horizontal roller-support for the shoulder girdle with the possibility of movement in the vertical direction and fixation in a certain position. The patient sits on a chair, so that the support is located on the side of the dislocated arm. The arm hangs through the support roller, the shoulder girdle abuts against the axillary fossa. For complete relaxation, the legs are bent at the knee joint, extended and the heel area is in contact with the floor. In this position, the patient should sit for 10-15 minutes, until the muscles of the freely hanging arm become relaxed. After that, the shoulder is repaired without much effort by the simultaneous smooth actions of the surgeon, who performs axial traction along the long axis of the shoulder for the forearm bent at right angles and the assistant, which leads the proximal shoulder to the side opposite the dislocation, using the flexible patient located in the axillary region traction, for example, in the form of a towel, making, if necessary, light rotational movements of the shoulder, while there is a reduction in the head of the shoulder into the articular cavity. Usually, the reduction occurs with a slight visible displacement of the shoulder head into the articular cavity, and there is no click sound, as in the known solutions, at the moment of reduction. The reliability of eliminating the dislocation is determined by the restoration of the contour of the shoulder girdle and the occurrence of free passive movements in the shoulder joint. After this, a plaster cast is applied and a control radiography of the damaged joint is performed.

Example 1. Patient L-va L.N., 52 years old (medical record of outpatient No. 263), 02/08/07, was admitted to the initial admission of the trauma unit H1 of the Central City Hospital of Cheboksary with a diagnosis of Closed anterior dislocation right shoulder. After clinical and radiological examination, conduction anesthesia, the patient was corrected with dislocation of the right shoulder in accordance with the above method, a plaster cast was applied, and control radiography of the damaged shoulder joint was performed. The direction of the dislocation of the shoulder was a displacement of the head into the articular cavity without the sound of clicking.

2. Patient Peninsula N.V., 58 years old (medical record of outpatient No. 393),

02/11/07 was admitted to the initial appointment of the trauma unit No. 1 of the Municipal Healthcare Institution “Central City Hospital” in Cheboksary with a diagnosis of closed front dislocation of the left shoulder. After clinical and X-ray examination, conducting conduction anesthesia, the dislocation of the left humerus was performed according to our proposed method on a chair for repositioning the dislocation of the shoulder. After this, a plaster cast was applied and a control radiography was performed. The direction of the shoulder occurred during axial traction with light rotational movements by a smooth displacement of the head into the articular cavity without a click.

Thus, examples of using the proposed method in the clinic for the reduction of shoulder dislocation in a clinic show that the dislocation is eliminated without the use of great effort, and there is no click at the moment the head is repositioned.

The method is gentle, effective and atraumatic, when the dislocation of the shoulder is repaired, there is no additional trauma to the tissues, brute force and sudden movements that cause damage to different morphological formations are not used at all stages of repositioning, all stages of the shoulder reposition are clearly controlled by the surgeon. The method deserves popularization and widespread adoption in a surgical clinic.

Claims (1)

A method of repositioning a shoulder dislocation by emphasizing the axillary region on a movable support, muscle relaxation, stretching the shoulder along the longitudinal axis with subsequent rotational movement in the shoulder joint, characterized in that the emphasis is on a movable support, made with the possibility of fixation, to relax the muscles, the patient is seated with elongated legs and focus on a fixed support fixed in accordance with the patient’s size, after which flexible traction is introduced into the axillary region and the proximal shoulder is displaced in the direction opposite to the dislocation, the shoulder extension along the longitudinal axis is performed for the forearm bent at a right angle simultaneously with the displacement of the proximal shoulder and, making light rotational movements, the shoulder head is directed towards the articular cavity.