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Interventions for treating acute elbow dislocations in adults

Elbow dislocation is where the joint surfaces of the elbow become completely separated from each other. It is a relatively uncommon injury. After the bones of the elbow joint are put back into place, under sedation and/or anaesthesia, the arm is usually immobilised in a cast for a week or more. Removal of the cast is often followed by physical therapy aimed at restoring elbow mobility. Surgery is usually reserved for the more severe dislocations, which are generally associated with a fracture (broken bone).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Surgical versus conservative for treatment for acromioclavicular dislocations of shoulder in adults

The acromioclavicular joint is located at the top of the shoulder. It is the joint between the lateral (outer) end of the clavicle (collar bone) and the acromion (a projection from the scapula, or shoulder blade, which is located at the point of the shoulder). Acromioclavicular dislocation is one of the most common shoulder problems treated in general orthopaedic practice.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Surgical approaches for dislocations of the neck bones

The part of the back bone found in the neck is called the cervical spine. It consists of seven bones (or vertebrae). The relative movement of these vertebrae is mainly via small joints (called facet joints) located between each vertebrae. The facet joints in the cervical spine facilitate good movement of the neck, but they are vulnerable to dislocation. Typically, cervical spine facet dislocations are caused by high‐energy traumas such as road traffic accidents or violent attacks. Approximately half of people with such dislocations sustain an injury to the spinal cord carried within the spine. This can result in significant impairment of function (e.g. paralysis). Surgery is usually needed for these serious injuries in order to keep the neck bones in place.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Treatments for dislocation of the hip after Total Hip Replacement surgery

It is not known what the best treatment for dislocation of the hip after Total Hip Replacement surgery is. This is because no evidence was found that looked at the treatments for dislocation of the hip after surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Surgical versus non‐surgical treatment for acute anterior shoulder dislocation

Acute anterior shoulder dislocation occurs where the top end of the humerus (the upper arm bone) is pushed out of the joint socket in a forward direction, usually as a result of an accident such as a fall. Initial treatment requires putting the joint back together. Subsequent treatment is either non‐surgical, involving placing the arm in a sling followed by exercises, or surgical, involving repair of damaged structures or cleaning up the joint space.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Non‐surgical management after non‐surgical repositioning of traumatic anterior dislocation of the shoulder

Acute anterior shoulder dislocation is an injury in which the top end of the upper arm bone is pushed out of the joint socket in a forward direction. Afterwards, the shoulder is less stable and is prone to re‐dislocation or subluxation (partial re‐dislocation), especially in active young adults. Initial treatment involves putting the joint back in place. This is called 'closed reduction' when it is done without surgery. Subsequent treatment is often conservative (non‐surgical) and generally involves placement of the injured arm in a sling or in another immobilising device followed by specific exercises.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Surgical versus non‐surgical treatment after kneecap dislocation

The patella or kneecap is a lens‐shaped bone situated at the front of the knee. It is incorporated into the tendon of the quadriceps muscles of the thigh and moves within a groove at the lower end of the thigh bone (femur). Patellar dislocation occurs when the patella completely moves out of this groove. It typically occurs in young and physically active people with minimal trauma when they twist the bent knee with the foot fixed to the ground, for example, during sporting activities. The most common recurrent symptom reported by people is patella or knee cap instability. It may be associated with abnormal shape of the knee joint bones, weakness of the muscles around the hip or knees or tightness of soft tissues on the outside of the knee.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Surgical interventions for the treatment of anterior shoulder instability

Shoulder instability represents a spectrum from micro‐instability through subluxation (partial dislocation) to frank dislocation and may occur as a result of different underlying pathologies. Anterior shoulder instability occurs when the humeral head moves out of its shallow joint socket in forward direction, usually following an injury such as a fall on the outstretched hand. Dislocation occurs when the head of the humerus moves completely out of the socket. As it does so, various ligaments around the joint may be torn and the bone of the humeral head or of the socket may be damaged. Recurrent episodes of dislocation are common unless complete healing of the damaged structures occurs. A 'Bankart lesion' is a type of tear involving the lining of the socket part of the shoulder joint. Such a tear predisposes the shoulder dislocate easily and in a recurrent manner. If recurrent episodes are troublesome, surgical repair using an open or minimally invasive (keyhole) technique may be advised and this principally involves the repair of 'Bankart lesion'.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Supportive devices for preventing and treating subluxation of the shoulder after stroke

There is insufficient evidence to conclude that supportive devices are effective in the prevention and treatment of subluxation of the shoulder after stroke. Shoulder subluxation is one of the most common secondary musculoskeletal problems after stroke which can cause pain and hinder the recovery of upper limb function. Supportive devices have traditionally been applied to treat shoulder subluxation. This review of four trials found insufficient evidence to conclude whether supportive devices prevent subluxation or not and found no evidence to conclude whether supportive devices can reposition the head of humerus in the glenoid fossa of an already subluxed shoulder.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Injection of lignocaine into a dislocated shoulder joint versus injection of a pain‐relieving drug with or without injection of a sedative drug into a vein for the purpose of manual manipulation of acute (less than 48 hours old) anterior (towards the front) displacement of a shoulder joint from its normal position.

Joint dislocation refers to displacement of the bones which form a joint away from their anatomical position. The shoulder is the most commonly dislocated joint managed in the emergency department (ED). When the dislocation occurs towards the front of the body, this is known as an anterior shoulder dislocation. It is called an acute anterior shoulder dislocation if the dislocation occurred with the previous 48 hours. Manually manipulating the displaced bones back to their normal position (manual reduction) is very painful. To allow for manual reduction, pain relief can be achieved either by injecting a local anaesthetic drug (for example, lignocaine) into the dislocated shoulder joint (intra‐articular lignocaine injection); or by injecting a pain killer with or without a sedative directly into the bloodstream through a vein (intravenous analgesia). The review authors searched the medical literature and identified five studies comparing these two methods. The studies included 211 patients with acute anterior shoulder dislocation; 113 patients underwent intra‐articular lignocaine injection and 98 underwent intravenous analgesia with sedation. The review found that there may be no difference in the immediate success of manual reduction of the dislocated shoulder between patients receiving intra‐articular lignocaine injection and those who received intravenous analgesia and sedation. However, intra‐articular lignocaine injection may be associated with fewer side effects and a shorter stay in the emergency department before discharge from hospital. Compared with intravenous analgesia and sedation, intra‐articular lignocaine may also be cheaper. However, the relatively small number of studies included in the review and the relatively small number of patients in each study means that the results of the review preclude definitive conclusions regarding the superiority of either method..

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Screening methods for dislocated or improperly formed hips in newborn infants

The hip joint is a ball and socket joint. Newborns may have hips that are not in their socket (dislocated) or hips that are improperly formed (dysplasia). Risk factors for hip dysplasia include a family history of a similar problem and female infants delivered in the breech position. The hips of most newborns will be examined clinically after birth and during infancy to determine whether they are stable, unstable or dislocated. Screening for hip dysplasia may prevent the need for late treatment, which is associated with long term hip deformity, gait disturbance and arthritis. However, early screening leads to increased treatment. Treatment may be complicated by damage to the hip due to impairment of the blood supply (avascular necrosis).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Occupational therapy after hip replacement

Total hip arthroplasty (THA) is a common surgical procedure for the treatment of pain and disability cause by osteoarthritis. Following THA, people have usually been provided with equipment, such as raised toilet seats and chairs, and educated to avoid activities that could cause the hip joint to be in a position of bending, twisting or where people cross their legs. These interventions aim to reduce the chances of dislocating the new hip, which is a painful and disabling event. This advice and equipment provision is often led by occupational therapists after a THA. We wanted to find out whether these types of treatments improve a person's recovery following a THA.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Interventions for treating adults with an isolated fracture of the ulnar shaft

The ulna is one of the two bones of the forearm. Isolated fractures of the shaft of the ulna, without other fractures, often result when the forearm is raised to fend off a blow. Such fractures are fairly rare, but can result in significant disability. Most people are treated in outpatients with plaster casts or arm braces. Some are treated surgically. Surgery generally involves the re‐alignment and fixation of the broken ends of the bone.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Interventions designed to prevent healthcare bed‐related injuries in patients

Patients in hospitals, nursing care facilities and rehabilitation units sometimes fall out of bed. Associated injuries include skin lacerations, bone fractures, joint dislocations and brain haemorrhage, and these injuries may result in permanent disability and death. Bed rails are the most common intervention designed to prevent patients falling out of bed. However, reports of fatal bed rail entrapment have caused uncertainty regarding their use. Determining which interventions effectively and safely prevent patient injuries from their beds would be beneficial and allow healthcare staff an evidence‐based practice.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Passive movements for the treatment and prevention of contractures

This Cochrane systematic review determines the effects of passive movements for contractures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Interventions for treating shoulder fractures in adults

Fracture of the top end of the upper arm bone (proximal humerus) is a common injury in older people. It is often called a shoulder fracture. The bone typically fractures (breaks) just below the shoulder, usually after a fall. Most of these fractures occur without breaking the skin lying over the fracture. The injured arm is often supported in a sling until the fracture heals sufficiently to allow shoulder movement. More severe (displaced) fractures may be treated surgically. This may involve fixing the fracture fragments together by various means. Alternatively, the top of the fractured bone may be replaced (half 'shoulder' replacement: hemiarthroplasty). More rarely, the whole joint, thus including the joint socket, is replaced (total 'shoulder' replacement). Physiotherapy is often used to help restore function.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Total hip arthroplasty for osteoarthritis

In people with osteoarthritis of the hip, there is not enough evidence to be certain about whether the posterior (back) or the lateral (side) approach to total hip replacement surgery is better.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Different methods of manipulation for reducing pulled elbow in young children

Pulled elbow is a dislocation of the elbow joint in a young child which is usually caused by an adult, or taller person, suddenly pulling or tugging on the child's arm when it is straight; or when a child pulls away from an adult impulsively. The child immediately complains of pain and cannot use their arm.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Conservative treatments for whiplash

Whiplash is defined as an acceleration‐deceleration mechanism of energy transfer to the neck. It may result from rear‐end or side‐impact motor vehicle collisions or during diving, among other mishaps.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Surgical approaches for inserting hemiarthroplasty of the hip

Arthroplasty (total hip replacement) involves replacing both the socket in the hip and the thigh side of the joint with an artificial joint. Hemiarthroplasty (partial hip replacement) leaves the socket intact, replacing only the thigh side. This is used for some people with hip fractures. Anterior surgery (from the front) might reduce the risk of dislocation and damaging the sciatic nerve for the leg, while posterior surgery (from the back) may reduce operating time and lower the risk of fracture. However, the review of trials did not find enough evidence to show which type of surgery for hemiarthroplasty is best.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

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