DISLOCATION

DEFINITION
Dislocations are joint injuries that force the ends of your bones out of position. The cause is often a fall or
a blow, sometimes from playing a contact sport. You can dislocate your ankles, knees, shoulders, hips,
elbows and jaw. You can also dislocate your finger and toe joints. Dislocated joints often are swollen, very
painful and visibly out of place. You may not be able to move it.
A dislocated joint is an emergency. If you have one, seek medical attention. Treatment depends on which
joint you dislocate and the severity of the injury. It might include manipulations to reposition your bones,
medicine, a splint or sling, and rehabilitation. When properly repositioned, a joint will usually function and
move normally again in a few weeks. Once you dislocate a shoulder or kneecap, you are more likely to
dislocate it again. Wearing protective gear during sports may help prevent dislocations.
http://www.nlm.nih.gov/medlineplus/dislocations.html
A dislocation is a separation of two bones where they meet at a joint. Joints are areas where two bones
come together.
Dislokasi adalah terlepasnya kedua tulang dari tempatnya bertemu yaitu persendian, dimana tulang
sudah tidak lagi berada pada posisinya yang normal.
A dislocated bone is no longer in its normal position.
http://www.nlm.nih.gov/medlineplus/ency/article/000014.htm

ETIOLOGI
Dislocations can occur in contact sports, such as football and hockey, and in sports that
may involve falls, such as downhill skiing, gymnastics and volleyball. Basketball players
and football players also commonly dislocate joints in their fingers and hands by
accidentally striking the ball, the ground or another player.
A hard blow to a joint during a motor vehicle accident is another common cause of
dislocation, as is landing on an outstretched arm during a fall.
Dislokasi dapat terjadi akibat :
- Cedera olahraga
- Trauma seperti benturan pada saat kecelakaan
FAKTOR RESIKO
Risk factors for a joint dislocation include:
Beberapa faktor resiko terhadap dislokasi sendi, diantaranya :
Susceptibility to falls. Experiencing a fall exposes you to the possibility of a
dislocated joint, if you use your arms to brace for impact or if you land forcefully on a
body part, such as your hip or shoulder.
Kemungkinan untuk terjatuh ketika seseorang terjatuh maka terjadi
peningkatan akan faktor resiko dari dislokasi, jika seseorang menggunakan
tangannya untuk menahan tubuh ketika terjatuh atau bagian dari tubuh seseorang
mengalami benturan keras saat terjatuh seperti panggul dan bahu.
Heredity. Some people are born with ligaments that are looser and more prone to
injury than those of most people.
Keturunan beberapa orang dapat terlahir dengan ligamen yang jauh lebih
longgar sehingga lebih meningkatkan faktor resiko dari dislokasi ketika terluka.
Sports participation. Many dislocations occur during participation in high-impact or
contact sports, such as gymnastics, wrestling, basketball and football.
Berolahraga Dislokasi sering terjadi ketika seseorang melakukan olahraga
dimana banyak terjadi kontak antar pemain atau high impact sports seperti sepak
bola, basket, hoki, dan gulat (wrestling).
Motor vehicle accidents. These are the most common cause of hip dislocations,
but you can greatly reduce your risk of injury by wearing a seat belt.
Kecelakaan ketika berkendara Hal ini yang paling sering menyebabkan dari
dislokasi panggul atau hip dislocation
GEJALA KLINIS
Symptoms
A dislocated joint may be:
Accompanied by numbness or tingling at the joint or beyond it
Intensely painful, especially if you try to use the joint or bear weight on it
Limited in movement
Swollen or bruised
Visibly out of place, discolored, or misshapen
Kadang disertai oleh mati rasa atau tebal dan kesemutan (numbness and tingling)
Adanya rasa nyeri terutama bila sendi tersebut digunakan atau diberikan beban
Pergerakan dari sendi yang terbatas
Terdapat bengkak dan kebiruan atau memar pada daerah persendian.
Sendi kadang terlihat tidak pada posisi anatomisnya, adanya perubahan warna maupun bentuk
Nursemaid's elbow is a partial dislocation common in toddlers. The main symptom is refusal to use the
arm. Nursemaid's elbow can be easily treated in a doctor's office.

KOMPLIKASI
Complications of a joint dislocation may include:
Komplikasi pada dislokasi sendi diantaranya :
Tearing of the muscles, ligaments and tendons that reinforce the injured joint
Robeknya dari otot, ligament ataupun tendon akibat sendi yang terluka
Nerve or blood vessel damage in or around your joint
Kerusakan dari saraf maupun pembuluh darah pada maupun sekitar daerah sendi
Susceptibility to reinjury if you have a severe dislocation or repeated dislocations
Kesempatan terjadinya luka berulang (reinjury) bila seseorang mengalami dislokasi
yang berat ataupun berulang
Development of arthritis in the affected joint as you age
Perkembangan dari peradangan sendi (arthritis) seiring bertambahnya usia
If ligaments or tendons that support your injured joint have been stretched or torn, or if
nerves or blood vessels surrounding the joint have been damaged, you may need
surgery to repair these tissues.
http://www.mayoclinic.org/diseases-conditions/dislocation/basics/complications/con-
20022264

HIP DISLOCATION
A traumatic hip dislocation occurs when the head of the thighbone (femur) is forced out of its socket in the hip bone
(pelvis). It typically takes a major force to dislocate the hip. Car collisions and falls from significant heights are
common causes and, as a result, other injuries like broken bones often occur with the dislocation.
Dislokasi panggul karena trauma dapat terjadi ketika caput femur keluar dari daerah acetabulum (socket) pada
pelvis. Dislokasi ini dapat terjadi apabila daerah tersebut mengalami benturan keras seperti pada kecelakaan mobil
ataupun jatuh dari ketinggian tertentu. Kadang dislokasi pada panggul juga dapat disertai adanya fraktur. Dislokasi
pada panggul merupakan jenis dislokasi yang amat serius dan membutuhkan penanganan yang cepat.
A hip dislocation is a serious medical emergency. Immediate treatment is necessary.
Anatomy
The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The
ball is the femoral head, which is the upper end of the femur (thighbone).
Daerah panggul memiliki persendian yaitu jenis sendi peluru atau artikulasio globaidea (ball and socket joint).
A smooth tissue called articular cartilage covers the surface of the ball and the socket. It creates a low friction surface
that helps the bones glide easily across each other.
The acetabulum is ringed by strong fibrocartilage called the labrum. The labrum forms a gasket around the socket,
creating a tight seal and helping to provide stability to the joint.


In a healthy hip, the head of the femur stays firmly within the acetabulum.
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Description
When there is a hip dislocation, the femoral head is pushed either backward out of the socket, or forward.
Posterior dislocation. In approximately 90% of hip dislocation patients, the thighbone is pushed out of the
socket in a backwards direction. This is called a posterior dislocation. A posterior dislocation leaves the
lower leg in a fixed position, with the knee and foot rotated in toward the middle of the body.
Dislokasi Posterior 90% dislokasi ini terjadi pada daerah panggul, dimana tulang femur terdorong keluar
dari socket atau acetabulum arah ke belakang (backward direction). Dislokasi posterior ditandai dengan
pergelangan kaki atas (tulang femur) yang berotasi interna dan adduksi, panggul dalam posisi fleksi namun
pada bagian lutut serta pergelangan kaki bawah justru pada posisi yang berkebalikan. Biasanya disertai
juga dengan penekanan dari nervus ischiadicus.
Anterior dislocation. When the thighbone slips out of its socket in a forward direction, the hip will be bent
only slightly, and the leg will rotate out and away from the middle of the body.
Dislokasi Anterior (Obturator Type) Dislokasi ini terjadi ketika tulang femur keluar dari acetabulum atau
socketnya dengan arah maju ke depan (forward direction) sehingga daerah panggul mengalami abduksi dan
rotasi eksterna menjauhi dari bagian tengah tubuh.
When the hip dislocates, the ligaments, labrum, muscles, and other soft tissues holding the bones in place are often
damaged, as well. The nerves around the hip may also be injured.
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Symptoms
A hip dislocation is very painful. Patients are unable to move the leg and, if there is nerve damage, may not have any
feeling in the foot or ankle area.
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Cause
Motor vehicle collisions are the most common cause of traumatic hip dislocations. The dislocation often occurs when
the knee hits the dashboard in a collision. This force drives the thigh backwards, which drives the ball head of the
femur out of the hip socket. Wearing a seatbelt can greatly reduce your risk of hip dislocation during a collision.
A fall from a significant height (such as from a ladder) or an industrial accident can also generate enough force to
dislocate a hip.
With hip dislocations, there are often other related injuries, such as fractures in the pelvis and legs, and back,
abdominal, knee, and head injuries. Perhaps the most common fracture occurs when the head of the femur hits and
breaks off the back part of the hip socket during the injury. This is called a posterior wall acetabular fracture-
dislocation.
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Doctor Examination
A hip dislocation is a medical emergency. Call for help immediately. Do not try to move the injured person, but keep
him or her warm with blankets.
In cases in which hip dislocation is the only injury, an orthopaedic surgeon can often diagnose it simply by looking at
the position of the leg. Because hip dislocations often occur with additional injuries, your doctor will complete a
thorough physical evaluation.
Your doctor may order imaging tests, such as x-rays, to show the exact position of the dislocated bones, as well as
any additional fractures in the hip or thighbone.
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Treatment
Reduction Procedures
If there are no other injuries, the doctor will administer an anesthetic or a sedative and manipulate the bones back
into their proper position. This is called a reduction.
In some cases, the reduction must be done in the operating room with anesthesia. In rare cases, torn soft tissues or
small bony fragments block the bone from going back into the socket. When this occurs, surgery is required to
remove the loose tissues and correctly position the bones.
Following reduction, the surgeon will request another set of x-rays and possibly a computed tomography (CT) scan to
make sure that the bones are in the proper position.

This x-ray, taken from the front, shows a patient with a posterior dislocation of the left hip.

Normal alignment after the hip has been reduced.
Complications
A hip dislocation can have long-term consequences, particularly if there are associated fractures.
Nerve injury. As the thighbone is pushed out of the socket, particularly in posterior dislocations, it can
crush and stretch nerves in the hip. The sciatic nerve, which extends from the lower back down the back
of the legs, is the nerve most commonly affected. Injury to the sciatic nerve may cause weakness in the
lower leg and affect the ability to move the knee, ankle and foot normally. Sciatic nerve injury occurs in
approximately 10% of hip dislocation patients. The majority of these patients will experience some nerve
recovery.
Osteonecrosis. As the thighbone is pushed out of the socket, it can tear blood vessels and nerves.
When blood supply to the bone is lost, the bone can die, resulting in osteonecrosis (also called avascular
necrosis). This is a painful condition that can ultimately lead to the destruction of the hip joint and
arthritis.
Arthritis. The protective cartilage covering the bone may also be damaged, which increases the risk of
developing arthritis in the joint. Arthritis can eventually lead to the need for other procedures, like a total
hip replacement.
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Recovery
It takes timesometimes 2 to 3 monthsfor the hip to heal after a dislocation. The rehabilitation time may be longer
if there are additional fractures. The doctor may recommend limiting hip motion for several weeks to protect the hip
from dislocating again. Physical therapy is often recommended during recovery.
Patients often begin walking with crutches within a short time. Walking aids, such as walkers, crutches and,
eventually, canes, help patients get mobilized.

Knee Conditions and Treatments
Patellar Dislocation
Patellar (kneecap) dislocations occur with significant regularity, especially in younger athletes. Most of the
dislocations occur laterally (outside). When these occur, they are associated with significant pain and swelling.
Following a patellar dislocation, the first step must be to relocate the patella into the trochlear groove. This often
happens spontaneously as the individual extends the knee either while still on the field of play or in an emergency
room or training room as the knee is extended for examination. Occasionally relocation of the patella occurs
spontaneously before examination and its occurrence must be inferred by finding related problems
Associated problems normally occur with patellar dislocations, the most obvious of which is tearing of the ligaments
that stabilize the kneecap itself. As is the case with all other joints, ligamentous disruption or tearing occurs to allow
the joint to dislocate. In the case of patellar dislocation, the ligaments on the inside of the knee are the most
commonly injured as the kneecap slides laterally. While tearing of these ligaments is unfortunate, they do have the
potential to heal. Of much more concern, are the small fragments of cartilage and bone that often are knocked off of
the kneecap or the lateral femoral condyle during the relocation of the kneecap. These fragments become loose
bodies and usually require removal during an arthroscopic procedure. Patellar dislocations can cause significant
quadriceps muscle injuries, which can be made worse due to the effusion within the knee or to early onset of
exercises and premature return to play.
Dislokasi patella paling sering disebabkan oleh robeknya ligamen yang berfungsi untuk menstabilkan dari sendi lutut
tersebut. Ligamen yang paling sering mengalami cedera dalam hal ini yaitu Ligamentum Collateral Medial, dimana
hal ini dapat terjadi ketika bagian lateral dari lutut mengalami suatu tekanan atau benturan keras. Padahal ligamen ini
membutuhkan waktu yang cukup lama untuk penyembuhannya. Dislokasi sendi lutut atau patella ini dapat
menyebabkan cederanya otot quadriceps, yang akan memperparah dalam hal ini terutama bila terjadi efusi pada
bagian lutut atau dalam keadaan terlalu cepat melakukan pemanasan, dan terlalu cepat untuk kembali melakukan
suatu aktivitas (olahraga).
A condition referred to as patellar subluxation also exists. The problem exists on a continuum between patellofemoral
malalignment and patellar dislocation. It can be sequelae of a traumatic dislocation or in situations where patellar
hyperlaxity exists. A subluxation is a partial dislocation in which the patella attempts to dislocate but does not do so
completely. Situations such as these are very disconcerting and often give the patients a sense of giving way or
buckling. At a minimum, these situations should be treated with aggressive therapeutic intervention as the constant
subluxation events not only will interfere with competition, but will also potentially cause repeated wear and
discomfort within the patellofemoral joint.

Causes
Patellar dislocations can occur either in contact or non-contact situations. An athlete can dislocate his/her patella
when the foot is planted and a rapid change of direction or twisting occurs. Usually a pre-existence ligamentous laxity
is required to allow a dislocation to occur in this manner. Direct blows to a knee can cause dislocations as well. The
force of these is obviously much greater and usually causes more severe damage especially to restraining ligaments.
Dislokasi sendi lutut dapat terjadi baik dalam situasi akibat terjadi kontak ataupun non kontak. Biasanya para atlet
dapat mengalami dislokasi sendinya apabila kaki dalam posisi diam bertumpu namun tejadi perubahan secara cepat
dalam arah atau posisi (twisting occurs).
Symptoms
Rapid, acute swelling.
Extreme pain initially until relocation occurs.
Continued pain along medial (inside) ligaments.
Discoloration medially at site of ligament injury.
Sense of instability and apprehension that problem will recur.
Treatment
Non-operative
Normal care of patellar dislocations, when a loose fragment has not been created is the immobilization of the knee for
a short period of time (seven to 10 days). During this time, the sw+++elling is reduced and the acute discomfort of the
dislocation decreases. Slow mobilization of the knee and of the patellofemoral joint is then begun, and usually full
recovery can be expected within a three to six week period. This period of time is significantly lengthened when the
patellar dislocation is recurrent.
Unfortunately, once a patellar dislocation occurs, especially when it occurs in a situation where hyperlaxity of the
ligaments exists, which is commonly the case, recurrent dislocations can be expected. These are significantly
problematic for athletes as they often come in the midst of the season. Conservative management of these problems
in season with appropriate rest, appropriate hip and thigh muscle strengthening, and perhaps the use of a patellar
buttress brace is appropriate.
Alternative Treatment Options
Glucosamine
Hyaluronic Acid
Non-steroidal Anti-inflammatory Medications (NSAIDs)
Operative
Some situations of patellar dislocation can and/or should be treated surgically. One situation is when recurrent
dislocations occur. In these situations, to limit the amount of lost time in competition and to reduce the chances for
cartilage lesions on the undersurface of the patella, which often are non-reparable, patellar stabilization procedures
are appropriate. These procedures can be either soft tissue or bone procedures, or a combination thereof. First-time
traumatic patellar dislocations can also be treated with procedures such as this, and in chosen situations doing so
may be appropriate.
It has been found in retrospective studies that the incidence of recurrent dislocation after the first dislocation occurs
can be as high as 40 percent. Surgically treating those dislocations by lessening lateral tension and tightening medial
restraint could reduce this recurrence rate to below 10 percent.
Surgical procedures on the patella are usually done in the out-patient setting. Procedures limited to altering soft-
tissue tension begin rehabilitation within a week and return to activity can be expected as early as six weeks.
Procedures that require bone work (osteotomies) require a period of relative immobilization and need 10 to 12 weeks
before a return to athletic activity is permitted.

KNEE DISLOCATION
Knee Dislocation Overview
A knee dislocation occurs when the bones that form the knee are out of place. A knee dislocation, more
specifically, is when the bones of the leg (the tibia and fibula) are moved in relation to the bone in the
thigh (femur). The bones of the knee are held together by strong bands of tissue called ligaments. Each
ligament is responsible for stabilizing the knee in a certain position. For a knee dislocation to occur, these
ligaments must tear. A partial dislocation is referred to as a subluxation. In some injuries,
the kneecap (patella) and its ligaments are also disrupted.
Inappropriate or delayed treatment of a knee dislocation may result in loss of the leg.

Figure 1. Picture of knee dislocations plus ligament and artery damages.
SOURCE: Medscape
Knee Dislocation Causes
Knee dislocations are rare. They usually happen only after major trauma, including falls, car crashes, and
other high-speed injuries.
If the knee is dislocated, it will look deformed. The usual straight line of the leg will be crooked or
angulated.
Sometimes, knee dislocations relocate (go back into place) on their own. In this case, the knee will be
very swollen and painful. Even if the knee relocates, usually significant damage (tearing) of ligaments
has occurred.
Dislokasi pada sendi lutut jarang terjadi. Hal ini terjadi akibat trauma yang cukup besar seperti terjatuh,
tabrakan mobil, dan cedera yang terjadi secara cepat. Bila sendi lutut mengalami dislokasi, maka akan
terlihat terjadinya deformitas. Bentuk dari kaki akan terlihat bengkok atau mengalami angulasi. Kadang
dislokasi pada sendi lutut ini akan mengalami relokasi secara sendiri. Lutut dalam hal ini akan menjadi
sangat bengkak dan sakit.
Knee Dislocation Symptoms and Signs
Knee dislocation will always cause severe pain in the knee. Sometimes, there will be no feeling below the
knee. If the knee relocates, it will become swollen from fluid in the knee and be painful with any
movement. Very serious symptoms include loss of a pulse below the knee or loss of feeling or movement
below the knee.
When to Seek Medical Care
If a dislocated knee injury is suspected, there is likely severe ligament injury. Go to the nearest
hospital's emergency department. Seek care for these reasons:
Extreme pain or swelling after a serious injury (such as a car crash)
An obvious deformity of the knee
Numbness in the foot
No pulses in the foot
Go to the hospital's emergency department for medical care for a dislocated knee immediately
Exams and Tests
Depending on how the knee looks, the doctor will check the injury for proper diagnosis in the following
ways:
X-rays: X-rays will be taken to make sure there are no breaks in the bone.
Examination of pulses: Injury to the arteries in the knee is common with this injury. The doctor will
make sure there are pulses in the foot.
An arteriogram (X-ray of the artery): This X-ray may need to be done to detect injuries to the artery.
Some medical centers may also use special ultrasound or Doppler (sound wave) machines to assess
the blood flow in the arteries.
Examination of nerves: Nerves also run through the knee, so it is possible that they may have been
damaged. The ability to feel touch and to move certain muscle groups are the main ways nerves are
tested. Specifically, the ability to move the foot up and down and to turn the foot inside (inversion) and
outside (eversion) are important muscle movements to examine. Any feeling of numbness is
concerning for nerve injury.
Knee Dislocation Treatment
Self-Care at Home
This injury should not be cared for at home. It is best to get medical care as soon as possible.
Placing ice on the injured area may help for some pain control and to decrease some of the swelling. But
the most important treatment is to have a doctor assess the injury and relocate or put the knee back in
place
Medical Treatment
Relocation: The doctor will move your lower leg back into position, a process called reduction. Most
doctors will do reduction after a person has been given pain medication or is given "conscious
sedation," where the patient is sedated enough to withstand the discomfort of relocation but not
completely sedated. Relocation is an important early step in repairing damage to nerves, blood
vessels, ligaments, and other tissues of the knee. Relocation is usually done by emergency and
orthopedic doctors.
Immobilization: To keep further injury from happening and to help with the beginning of healing, the
entire knee joint will be kept in a splint or immobilizer. This will keep the knee from bending and help
the tissues to start healing.
Referral: A knee dislocation almost always has severe tears and sprains of the ligaments and
sometimes has breaks in the bones of the knee. After swelling has gone down, the knee may need
reconstruction surgery to regain function. A bone specialist (orthopedist) will need to see you after this
injury.
Follow-up
The knee should be immobilized with bracing or casting, and the patient will be given crutches.
Do not put weight on the affected leg. Elevate the leg as much as possible.
Follow up with the orthopedist.
Prevention of Knee Dislocation
Attempt to avoid major accidents.
Avoid risky activities such as skiing, motorcycle riding, or jumping from high places; if people decide to
do these high-risk activities, they should obtain and follow instructions from experts about how to
decrease their risks.
Prognosis of Knee Dislocation
In general, this is a very serious injury. Recover is possible, but often the injured knee does not regain its
previous capacity to adsorb stresses. It is not uncommon for doctors to recommend some types of
supportive wraps or devices to protect the knee and to reduce stresses on it, especially during activities
like skiing or playing football. Some knee dislocations cause so much damage that some doctors will
suggest that certain activities are avoided altogether.
Almost all knee dislocations require reconstruction surgery because major injury to the artery occurs in
21%-32% of all knee dislocations and because of the severe ligament injury.
After appropriate treatment and surgery, however, results have been good. Knees return close to
normal in most cases.Chronic pain is a common problem, occurring in 46% of cases. The prognosis is
best with an optimal rehabilitationexercise program


Dislocated Ankle
Injuries > Ankle > Dislocated Ankle

(Also known as Ankle Dislocation)

What is a dislocated ankle?
A dislocated ankle is a condition characterized by damage and tearing of the connective tissue surrounding the ankle
joint with subsequent displacement of the bones forming the joint so they are no longer situated next to each other.
The lower leg comprises of 2 long bones, known as the fibula and the tibia, which are situated beside each other
(figure 1). These bones join with each other and the talus to form the ankle joint (figure 1). The ankle joint comprises
of strong connective tissue surrounding the joint known as the joint capsule and several ligaments providing
additional stability. Numerous muscles around the ankle provide additional support.
During certain movements of the ankle, stretching forces are applied to the ankle joint capsule. When these forces
are excessive and beyond what the ankle can withstand, tearing of the connective tissue may occur. This may allow
the ankle bones to move out of their normal position if the forces involved are too great and beyond what the
connective tissue and supporting muscles can withstand. When this occurs, the condition is known as a dislocated
ankle.
Due to the large forces required to dislocate the ankle, this condition usually occurs in combination with other injuries
of the foot, ankle or lower leg such as fractures or severe (Grade III) ankle sprains.

Dislokasi pergelangan kaki (ankle) adalah suatu kondisi dimana rusaknya dan robeknya
jaringan konektif di sekitar pergelangan kaki disertai dengan berubahnya posisi tulang dalam
suatu daerah persendian. Pergelangan kaki terdiri dari dua tulang yaitu tulang fibula dan tibia
yang berdampingan. Kedua tulang ini turut membangun persendian dari pergelangan kaki
(ankle joint). Sendi pergelangan kaki terdiri atas kapsul sendi dan beberapa ligamen yang
membantu kestabilan dari persendian. Dalam pergerakannya, stretching atau pemanasan yang
berlebihan dapat merusak dari jaringan konektif yang ada, sehingga tulang pada persendian ini
keluar dari posisi normalnya atau mengalami dislokasi.
Causes of a dislocated ankle
A dislocated ankle typically occurs traumatically due to forces pushing the ankle bones apart. This may occur due to
a direct impact, motor vehicle accident or more commonly, due to a severe ankle sprain whereby the ankle is rolled
excessively. Ankle dislocations are occasionally seen in sports requiring rapid changes of direction such as rugby,
soccer, basketball, netball and football. The usual mechanism of injury is an extreme combination of pointing the foot
and ankle downwards (plantarflexion figure 2) whilst turning the foot either inwards (inversion figure 3) or
outwards (eversion figure 4) excessively during weight bearing.
Dislokasi pergelangan kaki biasanya terjadi akibat trauma atau terjadi dorongan yang
keras terhadap tulang pergelangan sehingga terpisah. Hal ini dapat terjadi akibat
benturan langsung, kecelakaan motor atau pun cedera berat pada pergelangan
tersebut (severe sprain). Mekanisme dari dislokasi ini diakibatkan kombinasi dari
posisi plantar flexi pada bagian pergelangan kaki namun kaki juga mengalami baik
inversi maupun eversi agar dapat menahan beban.
Signs and symptoms of a dislocated ankle
Patients with a dislocated ankle usually experience sudden severe pain at the time of injury. The pain is usually so
intense that the patient cannot continue activity and will limp or be unable to weight bear at all. Pain is usually felt in
the ankle region, however can occasionally radiate into the foot, lower leg or calf.
Seseorang dengan dislokasi pada pergelangan kakinya biasanya akan merasakan nyeri yang sangat hebat ketika
mengalami cedera. Nyeri tersebut bahkan dapat membuat pasien tidak dapat melakukan aktivitas serta menahan
beban sama sekali. Nyeri biasanya dirasakan pada bagian pergelangan kaki namun dapat terjadi penjalaran nyeri
pada bagian kaki sekitarnya. Nyeri sendiri dapat dirasakan ketika bagian pergelangan kaki tersebut disentuh. Selain
nyeri didapatkan juga bengkak dalam hal ini. Pergerakan dari sendi lutut ini juga akan semakin terbatas akibat
membengkaknya daerah sendi dalam hal ini. Mati rasa atau kebas dan kesemutan juga dapat dirasakan pada bagian
pergelangan kaki ataupun daerah penjalarannya. Hal ini membutuhkan tindakan dan penangan segera dari ahli
ortopedi.
Patients with this condition will often experience a sensation of the ankle 'moving out' at the time of injury. Swelling
and a visible deformity of the ankle may be detected when compared to the other side along with bruising which may
become more visible over time. Pain will usually increase on firmly touching the affected region of the ankle joint.
Loss of ankle movement is usually experienced which may worsen over the coming days as swelling increases.
Occasionally, patients may experience pins and needles or numbness in the ankle, foot or toes.
Once a dislocated ankle has been 'relocated' (i.e. the bones put back into their normal position by a sports medicine
professional or orthopaedic specialist), patients may experience a feeling of weakness in the ankle and an ache that
may increase to a sharper pain with certain movements. These symptoms generally resolve over time with
appropriate rehabilitation. However patients with this condition may be left with a feeling of impending dislocation
when the ankle is placed in certain positions.

Diagnosis of a dislocated ankle
A thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose a dislocated
ankle. All ankle dislocations should be X-rayed to confirm diagnosis, assess the severity and rule out other injuries
(particularly fractures). Further investigations such as an MRI or CT scan may be required to assist with diagnosis
and assess the severity of the injury.

Treatment for a dislocated ankle
Before commencing treatment for a dislocated ankle, patients with this condition should have ankle X-rays to
determine if there are any fractures associated with the dislocation. This is particularly important in the case of
traumatic ankle dislocation where large forces are involved and should ideally occur before attempting to 'relocate'
the ankle bones. Following X-ray an experienced sports medicine professional or orthopaedic specialist can assist
with safely 'relocating' the ankle bones into their original position. This should not be attempted alone, as serious long
term damage may occur to other structures around the ankle such as nerves, blood vessels, bones, ligaments and
cartilage if the ankle relocation is performed incorrectly.
A review with an orthopaedic specialist is essential to ensure optimal management, particularly in the case of a
dislocated ankle with associated fractures. Treatment may involve anatomical reduction of any displaced fractures
(i.e. re-alignment of the fracture by careful manipulation under anaesthetic), surgical internal or external fixation to
stabilize the ankle or fracture (e.g. using plates and screws), the use a protective boot, brace, plaster cast and/or
crutches for a number of weeks. The orthopaedic specialist will determine the most suitable treatment based on a
number of factors including the severity of injury and any associated fractures.
Following relocation of the ankle and appropriate orthopaedic specialist treatment of any associated injuries (e.g.
fractures), all patients should undergo an intensive physiotherapy rehabilitation program. The success rate of
treatment is largely dictated by patient compliance. Treatment for a dislocated ankle usually entails an initial period of
immobilization for a number of weeks (e.g. in a plaster cast or protective boot) to allow the damaged connective
tissue to heal and form a 'scar'. During this period of immobilization, gentle exercises are often allowed as guided by
the orthopaedic specialist and physiotherapist.
Physiotherapy treatment and appropriate rehabilitation for a dislocated ankle can begin once the orthopaedic
specialist has indicated that it is safe to do so. One of the most important components of rehabilitation is that the
patient rests sufficiently from any activity that increases their pain (crutches and / or a protective boot are often
required). Activities which place large amounts of stress through the ankle should also be avoided, particularly
excessive weight bearing activity such as running, jumping, standing or walking excessively (especially up hills or on
uneven surfaces). Rest from aggravating activities allows the healing process to take place in the absence of further
damage. Once the patient can perform these activities pain free, a gradual return to these activities and weight
bearing forces is indicated provided there is no increase in symptoms. This should take place over a period of weeks
to months (depending on the severity of injury) with direction from the treating physiotherapist and orthopaedic
specialist.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or
prevent healing altogether.
Patients with a dislocated ankle usually benefit from following the R.I.C.E. Regime. The R.I.C.E regime is beneficial in
the initial phase of the injury (first 72 hours) or when inflammatory signs are present (i.e. morning pain or pain with
rest). This should involve resting from aggravating activities (i.e. use of crutches, a protective boot or brace), regular
icing, the use of a compression bandage and keeping the ankle elevated. Heat, alcohol and massage should also be
avoided in the initial 72 hour period following injury or when inflammatory signs are present. Anti-inflammatory
medication may also benefit those with a dislocated ankle by reducing the pain and swelling associated with
inflammation.
Patients with a dislocated ankle should perform pain-free flexibility, strengthening and balance exercises as part of
their rehabilitation to ensure an optimal outcome. Hydrotherapy exercises may also be recommended. This is
particularly important, as balance, soft tissue flexibility and strength are quickly lost with inactivity. The treating
physiotherapist can advise which exercises are most appropriate for the patient and when they should be
commenced.
Manual "Hands-on" Therapy from the physiotherapist such as massage, mobilization, dry needling, stretches and
electrotherapy can also assist with improving ankle range of movement and function following a dislocated ankle.
This can generally commence once the orthopaedic specialist or physiotherapist has indicated it is safe to do so.
In the final stages of rehabilitation for a dislocated ankle, a gradual return to activity or sport can occur as guided by
the treating physiotherapist provided there is no increase in symptoms.
It may be advised upon returning to some sports, particularly those sports requiring rapid change of direction, such as
football and netball, that the ankle is either taped or braced for additional support or protection. The treating
physiotherapist can advise if this is recommended.

Prognosis of a dislocated ankle
Many patients with a dislocated ankle heal well with appropriate physiotherapy and return to normal function. This
may take weeks to months to achieve an optimal outcome. However, due to the severity of injury and widespread
connective tissue damage associated with this condition, patients may experience long term effects. The most
common long term effect of a dislocated ankle is an increased likelihood of future dislocation or ankle sprain with
relatively minor trauma. In cases of recurrent ankle dislocation, surgical intervention may be indicated to increase the
ankle's stability. This is usually followed by an extensive rehabilitation program lasting many months.
Patients with a dislocated ankle who also have damage to other structures such as cartilage, bone or nerves are
likely to have a significantly extended rehabilitation period to gain optimum function.

Contributing factors to the development of a dislocated ankle
There are several factors which can predispose patients to dislocating their ankle. These need to be assessed and
where possible, corrected with direction from a physiotherapist. Some of these factors may include:
history of a previously dislocated ankle or ankle instability
inadequate rehabilitation following an ankle dislocation
participation in sports or activities placing the ankle at risk of dislocation
ankle weakness
ankle joint hyper mobility
Physiotherapy for a dislocated ankle
Physiotherapy treatment is essential for all patients with a dislocated ankle as inadequate rehabilitation can result in a
poor outcome with a high likelihood of re-injury. Physiotherapy can hasten the healing process, ensure an optimal
outcome and reduce the likelihood of recurrence. Treatment may comprise:
soft tissue massage
electrotherapy (e.g. ultrasound)
anti-inflammatory advice
joint mobilization
the use of crutches
the use of heel wedges
ankle taping
ankle bracing
ice or heat treatment
exercises to improve flexibility, strength and balance
hydrotherapy
education
activity modification advice
biomechanical correction
a gradual return to activity program
Other intervention for a dislocated ankle
Despite appropriate physiotherapy management, a small percentage of patients with a dislocated ankle do not
improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of
management. This may involve further investigations such as an X-ray, CT scan or MRI, pharmaceutical intervention,
corticosteroid injection or a review by a specialist who can advise on any procedures that may be appropriate to
improve the condition. Surgical intervention may be indicated to repair the torn connective tissue or to correct other
abnormalities associated with the dislocated ankle (such as fractures).

Exercises for a dislocated ankle
The following exercises are commonly prescribed to patients who are allowed to commence mobilization (as directed
from their orthopaedic specialist) following an ankle dislocation. You should discuss the suitability of these exercises
with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only
provided they do not cause or increase symptoms.
Foot and Ankle Up and Down
Move your foot and ankle up and down as far as possible and comfortable without pain (figure 5). Repeat 10 - 20
times provided there is no increase in symptoms.

Figure 5 Foot and Ankle Up and Down (left leg)
Foot and Ankle In and Out
Move your foot and ankle in and out as far as possible and comfortable without pain (figure 6). Repeat 10 -20 times
provided there is no increase in symptoms.

Figure 6 Foot and Ankle In and Out (right leg)

http://www.physioadvisor.com.au/13265050/dislocated-ankle-ankle-dislocation-physioadvis.htm

HIP DISLOCATION
Hip dislocations are relatively uncommon during athletic events.
[1]
Injuries to small joints (eg, finger, wrist,
ankle, knee) are much more common. However, serious morbidity can be associated with hip
dislocations, making careful and expedient diagnosis and treatment important for the sports medicine
physician.
Large-force trauma (eg, motor vehicle accidents, pedestrians struck by automobiles) are the most
common causes of hip dislocations.
[1, 2, 3, 4, 5]
This type of injury is also associated with high-energy impact
athletic events (eg, American football, rugby, water skiing, alpine skiing/snowboarding, gymnastics,
running, basketball, race car driving, equestrian sports).
[5, 6, 7, 8, 9, 10, 11]
Diagnosing and correctly treating
these injuries to avoid long-term sequelae ofavascular necrosis and osteoarthritis is imperative.
Dislokasi ini paling sering terjadi akibat kecelakaan dari kendaraan bermotor dimana akibat terbenturnya
lutut membentur dashboard sehingga terjadi deselerasi yang cepat dan tekanan dihantarkan dari femur
ke panggul. Diagnosis dan terapi yang tepat untuk menghindari akibat jangka panjang dari hal ini yaitu
nekrosis avaskuler dan osteoarthritis.
Dislokasi panggul terbagi menjadi dua yaitu dislokasi anterior dan dislokasi posterior tergantung berat
atau tidaknya trauma tersebut.
Hip dislocations are either anterior or posterior, with posterior hip dislocations comprising the majority of
traumatic dislocations.
Several classification systems are used to describe posterior hip dislocations.
o The Thompson-Epstein classification is based on radiographic findings.
Type 1 With or without minor fracture
Type 2 With large, single fracture of posterior acetabular rim
Type 3 With comminution of rim of acetabulum, with or without major fragments
Type 4 With fracture of the acetabular floor
Type 5 With fracture of the femoral head

Klasifikasi menurut Thompson-Epstein berdasarkan gambaran radiografi
- Tipe 1 : dislokasi sederhana dengan atau tanpa fragmen di dinding posterior acetabulum
- Tipe 2 : dislokasi dengan fragmen besar di dinding posterior acetabulum
- Tipe 3 : dislokasi dengan kominusi dinding posterior acetabulum
- Tipe 4 : dislokasi dengan fraktur pada dasar acetabulum
- Tipe 5 : dislokasi dengan fraktur pada caput femoris

o The Steward and Milford classification is based on functional hip stability.
Type 1 No fracture or insignificant fracture
Type 2 Associated with a single or comminuted posterior wall fragment, but the hip remains stable
through a functional range of motion
Type 3 Associated with gross instability of the hip joint secondary to loss of structural support
Type 4 Associated with femoral head fracture
o Some case series have found that most posterior hip dislocations are type 1.

Klasifikasi menurut Steward dan Milford berdasarkan fungsi stabilitas panggul
- Tipe 1 : Tidak ada fraktur atau fraktur yang tidak signifikan
- Tipe 2 : Terdapat satu atau fragmen kominutif dinding posterior, namun panggul masih cukup
stabil terutama dalam fungsinya ketika bergerak
- Tipe 3 : Terdapat ketidakstabilan dari sendi panggul sebagai akibat dari hilangnya struktur
pendukung
- Tipe 4 : Terdapat fraktur pada caput femoris
Paling sering terjadi yaitu kasus dislokasi tipe 1 dalam hal ini.

DISLOKASI ANTERIOR
Dislokasi anterior sering disebabkan tekanan hiperekstensi melawan tungkai yang abduksi sehingga
caput femur terangkat dan keluar dari acetabulum, caput femur terlihat di depan acetabulum. Caput
femur tetap berada di lateral pada otot obturator ataupun dibawahnya (dislokasi obturator) atau
dibawah otot iliopsoas dengan hubungan ke ramus pubis superior (dislokasi pubis).
Klasifikasi Dislokasi Sendi Panggul Anterior menurut Epstein yaitu :
- Tipe 1 : Dislokasi superior termasuk pubis dan subspinosa
1A Tidak terdapat fraktur
1B Terdapat fraktur atau impaksi dari caput femur
1C Terdapat fraktur dari acetabulum

- Tipe 2 : Dislokasi inferior termasuk obturator dan perineal
2A Tidak terdapat fraktur
2B Terdapat fraktur atau impaksi dari caput femur
2C Terdapat fraktur acetabulum


Indikasi untuk dilakukan operasi diantaranya
1. Pada seseorang dengan dislokasi yang disertai fraktur di daerah sekitar persendian
2. Pada dislokasi yang tidak dapat direposisi secara tertutup
3. Pada dislokasi yang memilki resiko ketidakstabilan dari sendi berulang, osteonekrosis, serta
arthritis pasca trauma

Stabil bersama dislokasi
Periarticular fraktur:
cedera Bersama melakukan yang terbaik saat latihan ROM bisa dimulai dini.
Patah tulang harus stabil untuk memungkinkan ROM awal.
Patah tulang juga harus dikurangi secara anatomis untuk mengurangi risiko artritis pasca
trauma.
Dalam beberapa kasus, pecah atau sobek jaringan lunak periarticular dapat diobati dengan
operasi.
dislokasi bahu akut pada dewasa muda memiliki resiko tinggi ketidakstabilan berulang.
Tereduksi bersama dislokasi:
Jaringan lunak seperti tendon, saraf, atau pembuluh darah boleh ditangkap pada sendi.
Terbuka pengurangan diperlukan.
Intra-artikular osteochondral fragmen
Tindak lanjut
Konfirmasi harus dilakukan setelah pengurangan, berhati-hati untuk memastikan harmoni
bersama.
Pasien harus ulang dalam 1-2 minggu.
Jika sendi stabil, ROM awal harus dimulai.
Dislokasi dapat menempatkan pasien pada risiko ketidakstabilan, osteonekrosis, atau arthritis
pasca trauma.



Prognosa
Prognosis tergantung pada sendi tertentu dislokasi dan cedera jaringan sekitarnya.
Cedera saraf dan arteri di sekitar sendi memiliki prognosis buruk.
fraktur Periarticular beresiko untuk arthritis posttraumatic dan kebutuhan untuk penggantian
nanti bersama.
dislokasi sendi terjawab memiliki prognosis buruk.
dislokasi bahu memiliki tingkat tinggi redislocation pada dewasa muda.
Pada pasien yang aktif, operasi dini mungkin dapat membantu dalam mencegah ketidakstabilan
kronis.
Komplikasi
Kekakuan
Osteonekrosis:
Paling umum setelah dislokasi pinggul.
Pemikiran menjadi sekunder untuk kerusakan pada suplai darah dari kepala femoralis.
Lamanya waktu untuk pengurangan secara langsung berkaitan dengan risiko osteonekrosis.
Pinggul harus dikurangi dalam waktu 6 jam.
Posttraumatic arthritis:
Tergantung pada pengurangan fraktur dan jumlah kerusakan chondral untuk sambungan pada
saat cedera
Dalam 1 studi hasil setelah fraktur dislokasi posterior pinggul, hasilnya yang jelek terlihat pada
18% pasien.
Umum setelah dislokasi subtalar hindfoot
Bersama ketidakstabilan:
Kehadiran patah dan kerusakan struktur sekitarnya mendukung meningkatkan gabungan risiko
ketidakstabilan terlambat.
Sendi dengan stabilitas bawaan yang kurang, seperti bahu, memiliki risiko lebih tinggi
ketidakstabilan terlambat daripada melakukan sambungan dengan lebih struktur bertulang stabil,
seperti siku.
Kerusakan saraf:
Awal pengurangan mengurangi jumlah waktu yang saraf yang meregang.
Setelah dislokasi hip, pasien dengan waktu lebih lama untuk pengurangan telah cedera saraf
buruk.
Pemantauan Pasien
Pasien harus dimonitor dengan radiografi untuk memeriksa bahwa sendi berkurang konsentris.
Tambahan tindak lanjut didasarkan pada cedera masing-masing.
Pasien dengan dislokasi hip harus diikuti radiografi untuk tahun 1 untuk menilai untuk arthritis
posttraumatic dan osteonekrosis.