shoulder dislocation open reduction

Fresh dislocation of the shoulder joint with humeral neck, dry fracture, or scapular fracture block embedded in the joint, or biceps long head embedded in the joint, or combined with blood vessels, nerve injury, should be open reduction. The old dislocation of children and young people should also be treated with open reduction. For old dislocations of middle-aged or older, such as articular cartilage degeneration, joint fusion should be used according to occupation and age at the time of open reduction. Arthroplasty or artificial joint replacement. On the contrary, the old dislocation of middle-aged and above, if asymptomatic, has a certain degree of activity, can not do any surgery. Treatment of diseases: fractures of the humerus and ulna styloid processes Indication Fresh dislocation of the shoulder joint with humeral neck, dry fracture, or scapular fracture block embedded in the joint, or biceps long head embedded in the joint, or combined with blood vessels, nerve injury, should be open reduction. Contraindications There are serious obstacles to the coagulation mechanism. High blood pressure, diabetes, and some bleeding-prone diseases. Preoperative preparation Correct the old dislocation of middle-aged or older, such as asymptomatic, and have a certain degree of activity, without any surgery. Surgical procedure 1. Position: When disinfecting, the patient takes the lateral position, hurts the shoulder, disinfects and drapes the towel, so that the patient takes the supine position and the injured shoulder pad is 30° high. 2. Incision and exposure: According to the anterior medial aspect of the shoulder joint (see the anterior medial aspect of the shoulder joint), the skin and subcutaneous tissue were cut, and the deltoid and pectoralis major muscles were separated, and cut under the clavicle and 0.5 cm below the shoulder. The deltoid muscle, the valgus muscle flap, and the pectoralis major muscle can be opened to reveal the humeral head wrapped by a layer of fibrous tissue. When the upper limb is gently rotated, the finger can touch the humeral head and its activity. Cut off part of the pectoralis major muscle attachment, and cut the tendon of the diaphragm and biceps short head 0.5 cm below the condyle and turn it down. Care should be taken not to damage the agitation, veins and brachial plexus that pass under the condyle. Then, clear the small nodules of the humerus, and rotate the humerus outward to find the attachment of the subscapularis muscle, cut it off, and expose the front of the shoulder joint. 3. Clean the shoulder blades: If it is fresh dislocation, the joint capsule's rupture is mostly in front of and below the shoulder blade. Cut the switch capsule along the rupture to remove the blood clots and bone fragments. In the case of old dislocation, the long head of the biceps muscle is traced back to the joint capsule, the switch capsule is cut inside the shoulder blade, the scar tissue in the joint is removed, and the cartilage and labial injury are identified, and the surgical design is modified. . When removing scar tissue, the joint capsule should be kept as much as possible. 4. Loosen the humeral head: After clearing the iliac crest, close the humeral head and open the adhesion, remove the fibrous tissue covering the humeral head and the scar tissue that affects the reduction of the humeral head, and gently rotate the humerus to loosen the upper end of the humerus. The fracture piece of the humeral large nodule is often located on the outside of the humeral head, or stuck near the shoulder blade. It can be opened with a periosteal stripper, clamped with a towel clamp, and turned to the upper side together with the external rotation muscle attached thereto. 5. Reposition, internal fixation: After clearing the scar tissue, pull the biceps femoris longus tendon. Traction the arm and make the abduction, adduction and internal rotation, while pushing the humeral head with the hand to the shoulder to reset it. After the reduction, the shoulder joint should be gently passively moved in all directions until it reaches the normal range, and it is observed whether the restored humeral head is easy to escape. If the fracture of the large tibial tuberosity is large, it can be fixed with a screw after reduction. Conversely, if the fracture block is small and can be caused by screw fixation, it can be fixed by Kirschner wire or suture around the fracture block with silk thread. The soft tissue is fixed. If the humeral head is easily dislocated when the shoulder joint is passively moved after the reduction, it should be fixed internally. At this time, an assistant can maintain a 45° abduction of the injured shoulder and a 20° flexion. The surgeon uses two Kirschner wires to cross the shoulder and the greater tibia. The stump was bent into a hook and left under the skin. It was pulled out 2 weeks after surgery. 6. Stitching: The ruptured joint capsule should be sutured as much as possible. The severed scapular muscle tendon should be sutured to strengthen the anterior wall to prevent recurrence. Then suture the diaphragm and biceps short head, deltoid muscle and skin. complication Phantom limb pain: also known as limb hallucination pain, refers to the limbs where the subjective feeling has been cut off still exists, and accompanied by severe pain, and the pain appears at the distal end of the broken limb, which is actually an illusion phenomenon.

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