CASE

A 12-year-old boy is brought to the physician’s office with

right thigh pain and a limp. His mother has noticed him
limping for the past week or so. He denies any injury to his
leg but says that it hurts some when he plays basketball with
his friends. He denies back pain, hip pain, or ankle pain. He
occasionally gets some pain in the right knee but does not
have any swelling or bruising. He has no significant medical
history, does not take any medications regularly, and
otherwise feels fine. On examination, he is an overweight
adolescent. His vital signs and a general physical examination
are normal.
When you have him walk, he has  a prominent limp. You note
that he seems to keep his weight on his left leg for a greater
proportion of his gait cycle than he does on the right leg.
Examination of his back reveals a full range of motion, no
tenderness, and no muscle spasm. He gets pain in the right hip
when it is passively internally rotated. When the hip is
passively flexed there is a noticeable external rotation. There
is no thigh muscle atrophy. His right knee and the remainder
of his orthopedic examination are normal.(37)

KEYWORDS
1. 12 years old boy
2. Right thigh pain and a limp
3. Gets some pain in the right knee
4. He is an overweight adolescent
5. He has prominent limp
6. Gets pain in the right hip when passively internal rotated
PROBLEM
Right thigh pain and a limp

DIFFERENT DIAGNOSE
1. Hernia nukleus pulposus
2. Fracture
3. Dislocation of femur dextra

HYPOTHESIS
A 12 years old boy with right thigh pain and a limp cause
dislocation of femur dextra

LEARNING ISSUE
Definition of dislocation
Dislocation 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. A dislocated joint in 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. A dislocation is a separation of two bones
where they meet at a joint joints are areas where two bones
come together.

Cause of dislocation
Dislocation 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 figers
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.

Symptoms of dislocation
A dislocated joint may be :
1. Accompanied by numbness or tingling at the joint or
beyond it
2. Intensely painful, especially if you try to use the joint or
bear weight on it
3. Limited in movement
4. Swollen bruised
5. Visibly out of place, discolored, or missaphen

Risk Factor
Risk factor for a joint dislocation include :
1. Susceptbility to falls
Experience 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
 2. Heredity
Some people are born with ligaments that are looser and
more prone to injury than those of most people
3. Sports participation
Many dislocations occur during partipation in high-
impact or contact sports, such as gymnastic, wrestling,
basketball and football
4. Motor vehicle accidents
There are the most common cause of hip dislocations,
but you can greatly reduce your risk of injury by wearing
a seat belt

Complications
Complications of a joint dislocation may include :
1. Tearing of the muscles, ligament and tendons that
reinforce the injured joint
2. Nerve or blood vessel damage in or around your joint
3. Susceptibility to reinjury if you have a severe dislocation
or repeated dislocations
4. Development of athritis in the affected joint as you age

Supporting Investigation
1. Radiologi
2. USG
3. CT-Scan
4. MRI
Treatment
1. Manipulation or respositoning : in this metho, your
doctor will manipulate or reposition the join back into
place. You’ll be given a sedative or anesthetic to remain
comfortable and also to allow the muscles near your joint
to relax, which eases the procedure.
2. Immobilization : to keep further injury from happening
and to help with the beginning of healing, the entire knee
joint will be kept in asplint or immobilizer. This will
keep the knee from bending and help the tissues to start
healing.
3. Medication: most of your pain should go away after the
joint returns to its proper place. However, your doctor
may prescribe a pain reliever or a muscle relaxant if
you’re still feeling pain
4. Rehabilitation : rehabilitation begins after your doctor
properly repositions or manipulates the joint into the
correct position and removes the sling or splint (if you
needed one). You and your doctor will devise a
rehabilitation plan that works for you. The goal of
rehabilitation is to gradually increase the joint’s strength
and restore its range of motion. Remember, it’s important
to go slowly so you don’t reinjure yourself before the
recovery is complete.

REFERENCE
 Patofisiology shilvy and price

Buku Gangguan Muskuloskeletal, 2009, salemba medika, Noor

Zairin. Page 234
 DISLOCATION

CREATED BY :

RIZKA DWI LESTARI

SARAH OKTALANDA
SARAS AYU SINTA YOKA
SARI FITRIA S. DINGKU
SEPTILIA EKA E.D

UNIVERSITAS MALAHAYATI
BANDAR LAMPUNG