The most common afflictions of the skeletal system are those induced by injury. In modern times injuries are encountered at an ever-increasing rate. Many councils and organizations direct their purpose at the prevention of injuries and have had remarkable success toward this goal. Still injuries are all too prevalent.
In many instances injuries of the skeletal system are multiple and associated with injuries of other systems. For the purpose of this post, injuries of this system may be divided into fractures, dislocations, and sprains.
Dislocation is a displacement of a bone from its normal relationship at a joint. With injury a bone is pulled or twisted out of its socket or other attachment to another bone. Dislocations are classified as closed or simple when the joint is not penetrated or open to the surface. The compound dislocation is one in which the joint is exposed to the surface by a break in the surrounding soft tissues. Dislocations are referred to as complete when there is total displacement of the gliding surfaces of the two opposed bones. Incomplete or partial dislocation is one wherein there still remains some contact of the bones’ joint ends.
The characteristics of a dislocation are also designated by the abnormal position the displaced bone takes in relationship to the joint, such as anterior (in front of) and posterior (behind) dislocation, etc. Dislocations which have fractures associated are termed fracture-dislo- cation. Dislocations which occur of the same joint on repeated occasions due to weakened joint ligaments are known as recurrent dislocations.
Diagnosis of dislocation may be quite apparent by the obvious external deformed contour of the region. In other instances, examination by feeling of the area may suggest dislocation. In all, however, the diagnosis must be ascertained by x-ray picture to determine whether there is associated fracture. An x-ray picture is also taken after reduction of dislocations to assure total replacement of the dislodged bone.
In general, the treatment of dislocations rests with reduction of the joint back into its normal position and immobilizing the joint for sufficient time for the ligaments around it to heal. Varying times of immobilization are necessary for different joints. The joints are held in their position of optimal function. Maintenance of the joint in its corrected normal position is accomplished by many different methods. Adhesive tape, strapping, splints, slings and harnesses, and bandages are employed. In some instances, plaster of paris casts are necessary. Bed rest is required for some.
Open operation for dislocations is not commonly indicated. In certain recurrent dislocations, however, such as at the outer end of the clavicle, closed methods may not be successful in restoring a stable joint. In such instances, repair of the ligaments and/or wiring of a joint may be necessary. In severe disabling recurrent dislocations of an important joint (the knee, for example), operation for joint fusion may be indicated.
A sprain is a minor tear in the ligaments about a joint, caused by forceful movement of the joint beyond its normal range of motion so that the fibers of the ligaments are stretched and torn. Sprain may occur to any joint. Most common is sprain of the finger joints; sprained ankle is the next in frequency; knee sprains are not uncommon. Treatment entails supporting the joint at rest, preferably with the joint bent toward the side of the injured ligaments. Adhesive tape, splints, slings and harnesses, and bandages are used. Casts sometimes are needed. Physical therapy may be indicated. Open operation may be required in severe tearing of important ligaments for their repair. In a few instances of “chronic sprain” where the ligaments are loosened, with an unstable joint, open surgery may benefit. The sacro-iliac joint, in the low back region where the spine joins the pelvis, is prone to instability, especially after it has once been injured. Treatment is most often by medical and physical therapy methods, but on occasion open operation to fuse this joint may be beneficial for stabilizing it.
Open wounds of joints may be caused by lacerations, penetrating objects, or blunt forces. When a joint is open to the surface, the likelihood of infection in the joint is great. Treatment is by debridement of all the contaminated and dead tissue from the wound and its surgical reconstruction. This should be done as soon as possible and all measures taken to prevent infection.
Hemarthrosis (blood-joint) is a condition of blood within a joint. It may be from injury or following surgery of a joint. In some instances the blood must be withdrawn.