Fractures & Dislocations

Periarticular fractures

Periarticular fractures occur in or immediately adjacent to a joint. Since joints allow movement of the limbs, a fracture of the bones at either end of a joint can cause severe pain and disability. Periarticular fractures most often occur in the ankle, leg (tibia), thigh (distal femur) and elbow, although they may involve any joint.

Treating periarticular fractures is more complex than treating regular bone fractures, because there are more structures and tissues in the joint that can be damaged as a result of the fracture. Furthermore, the ability to restore the alignment of the fracture fragments directly affects the long term outcome from such an injury.

Periprosthetic fractures

More Americans than ever before have had a joint replacement operation. On occasion, individuals who have had a joint replacement may injure themselves and sustain a fracture involving that limb. Periprosthetic fractures occur in the bone around an artificial joint replacement and can be very difficult to treat. They often require surgical expertise in both reconstruction and trauma.

In patients with periprosthetic fractures, orthopaedic surgeons at the Dallas Orthopaedic Trauma Institite strive to preserve the original joint replacement by using fixation devices to stabilize the fracture and encourage healing. This is not always possible, in which case a revision replacement is often a better option.
The collective experience of the surgeons at the Dallas Orthopaedic Trauma Institite in treating periprosthetic fractures is unrivaled in North Texas. The combined expertise of fracture care and joint replacement is essential in choosing the best treatment, and providing expert treatment of these challenging, and increasingly common, injuries.

What is a Dislocation?

A dislocation occurs when the bones that are usually be connected at a joint separate. You can dislocate a variety of different joints in your body, including your knee, hip, ankle, or shoulder.

Since a dislocation means your bone is no longer where it should be, you should treat it as an emergency and seek medical attention as soon as possible. An untreated dislocation could cause damage to your ligaments, nerves, or blood vessels.

What Causes Dislocations?

Dislocations typically result when a joint experiences an unexpected or unbalanced impact. This might happen if you fall or experience a harsh hit to the affected area. Once a joint has been dislocated, it is more at risk for dislocations in the future.

Who Is at Risk for Dislocations?

Anyone can dislocate joint if he or she has a fall or suffers some other type of trauma. However, elderly people tend to have a higher risk, especially if they lack mobility or are less able to prevent falls.

Children can also be at a greater risk for dislocations if they are unsupervised or play in an area that has not been childproofed. Those who practice unsafe behavior during physical activities put themselves at higher risk for accidents, such as dislocations, as well.
If you dislocated a joint in the past, the affected area could be more vulnerable to that injury in the future.

Recognizing a Dislocation

In many scenarios, you will be able easily to see a dislocation when it has occurred. The area may be swollen or look bruised. You may notice that the area is red or discolored. It may also have a strange shape as a result of the dislocation.

Some of the other symptoms associated with dislocated joints include:

  • loss of motion
  • pain during movement
  • numbness around the area
  • tingling feeling

Diagnosing a Dislocation

It may be difficult to determine whether your bone is broken or just dislocated. You should arrange an exam with your doctor as soon as you can.

Your doctor may move the affected area around to check your range of motion. If your doctor believes that you have a broken bone, he or she may request an MRI or X-ray to be taken. These imaging tools will enable your doctor to see exactly what is going on in your joint.

Treating Dislocations

Your doctor’s choice of treatment will depend on the joint that you may have dislocated. It may also depend on how severe your dislocation is. According to Johns Hopkins University, initial treatment for any dislocation involves R.I.C.E.—Rest, Ice, Compression, and Elevation. In some cases, the dislocated joint might go back into place naturally after this treatment (Johns Hopkins).

If the joint does not return to normal naturally, your doctor may use one of the following treatments:

  • manipulation or repositioning
  • immobilization
  • medication
  • rehabilitation

Manipulation

In this method, your doctor will manipulate or reposition the joint back into place. You will be given a sedative or anesthetic to remain comfortable and also to allow the muscles near your joint to relax, which eases the procedure.

Immobilization

Once your joint has returned to its proper place, your doctor may ask you to wear a sling or splint for several weeks. This will prevent the joint from moving and allow the area to fully heal. The length of time your joint needs to be immobilized will vary, depending on the location of the injury and how severe it is.

Medication

Most of your pain should go away once the joint is returned to its proper place. However, your doctor may prescribe a pain reliever or a muscle relaxant if you are still feeling pain.

Surgery

You will need surgery only if the dislocation has damaged your nerves or blood vessels, or if the doctor is unable to return your bones to the joint. Surgery may also be necessary for those who often dislocate the same joints, such as their shoulders.

Rehabilitation

Rehabilitation begins after the joint has been properly repositioned or manipulated into the correct position and the sling or splint has been removed (if you needed one). Your doctor will work with you to devise a rehabilitation plan that best works for you. The goal of rehabilitation is to gradually increase the joint’s strength and rebuild its range of motion. Remember, it’s important to go slowly, so you don’t reinjure yourself before the recovery is complete.

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