Therapy
In general, the joint should be repositioned as soon as possible, preferably within 6 hours. Otherwise there is a risk of vascular or nerve damage due to the close proximity. In the case of a dislocation without accompanying bony injuries, the aim is to reduce the joint and restore normal joint conditions.
For this purpose, the joint surface of the humerus must snap back into the joint cavity of the ulna. This is usually done under general anesthesia, since with regional anesthesia the feeling and the ability to move are still limited for a longer time, which can be dangerous. In the case of a dorsal dislocation, a traction is applied to the forearm, which is bent by approx.
30° and turned outwards, and this is then flexed up to 90°. In the case of a ventral dislocation, an attempt is made to lock the forearm down again when it is bent. After reduction, the joint must be checked by x-ray.
If ligament damage is suspected, the success of the reduction and the extent of the remaining instability of the joint should be assessed during anesthesia.In an awake patient, muscles attached to the joint can simulate stability. The examination is controlled by simultaneous rapid sequences of X-rays. Above all, it is important to check how the joint behaves when bending and flexing outwards or inwards.
If no further dislocation occurs, the treatment is conservative with a 1 to 2-week immobilization of the cast in the functional position (approx. 90° flexion). If there is instability compared to bending outwards or inwards, this period can be increased to 3 weeks.
However, physiotherapy should be started as soon as possible to prevent capsule shrinkage and muscle hardening. If a new luxation (dislocation) occurs during the functional check, especially when bending, or if the joint cannot be repositioned at all, surgery is indicated. The same applies if instability persists after conservative treatment (immobilization).
Surgery is also necessary if there is bone damage or nerve and vascular damage. During this procedure, the joint is repositioned, the bony structures are fixed in their original arrangement and the capsule-ligament apparatus is restored. An external fixator is often used to fix the joint and its parts.
In this case, the bony sections are fixed through the skin with screws. There is also a so-called movement fixator, which allows movement within a defined range. The advantage is that movement training can be started earlier. This is intended to minimize movement restrictions as a late consequence.
