= Modificarea permanenta a raporturilor dintre 2 suprafete...
Transcript of = Modificarea permanenta a raporturilor dintre 2 suprafete...
![Page 1: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/1.jpg)
= Modificarea permanenta a raporturilor dintre 2 suprafete articulare
![Page 2: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/2.jpg)
• Complete/incomplete
• Disjunctii = in diartro-amfiartroze (simf pub/artic acromio-clav)
• Diastaze = in sinartroze/sindesmoze (artic tibioperoniera inf)
![Page 3: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/3.jpg)
• Traumatice
• Inveterate – reducerea a fost amanata
• Ireductibile – au pierdut locul de domiciliu
• Recidivante/habituale
• Patologice = TB, polio (apar lent ca urmare a unor afect
premergatoare)
• Congenitale = displazia luxanta de sold (malf ale supraf
articulare)
![Page 4: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/4.jpg)
Mecanism de producere
- direct = cadere pe artic
- indirect = forta transmisa din distal prin intermediul diafizei
• 1. actiunea este in afara punctelor uzuale de presiune – se
creaza o bresa in mansonul capsulo-ligamentar ce permite
iesirea extremitatii osoase din articulatie = deplasarea
primara
• 2. greutatea membrului si contractura musculara permit
deplasarea secundara si fixarea luxatiei = deplasarea
secundara
![Page 5: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/5.jpg)
• Capsula – rupere longitudinala, paralela cu directia osului luxat
• Sinoviala se rupe in acelasi loc – hemartrozei
• Ligamentele – dezinserate, rupte, dilacerate
• Epifizele osoase prez lez discrete = smulg os parcelare, fisuri
osteocartil
• Lez asociate:
• Dezinsertii/ruperi ale tend periartic
• Compresiuni vasculare/nervoase
• Deschiderea luxatiei
• Devitalizari tegumentare
![Page 6: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/6.jpg)
• Durere – violenta la debut, difuza in urm zile, scade progresiv
in 2-3S
• Impotenta functionala totala la debut, se reduce progresiv
• Atitudine vicioasa +/- scurtare (caracteristica fiecarei luxatii)
• Deformarea regiunii
![Page 7: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/7.jpg)
Tratament – 3 timpi:
1. Reducerea – epifiza luxata parcurge traiectul invers + Rx
control
2. Mentinerea reducerii
3. Restabilirea functionala
Exercitii de contractii mm si mobilizare activa
![Page 8: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/8.jpg)
- presternala = ant - retrosternala = post - suprasternala = superioara
![Page 9: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/9.jpg)
![Page 10: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/10.jpg)
![Page 11: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/11.jpg)
![Page 12: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/12.jpg)
= pierderea contactului permanent intre cap hum si cav glenoida
= acuta/ veche/ recidivanta
Mec:
- Direct – traumatism/cadere pe p.post umar
- Indirect – cadere pe mana, cot, umar
- Contractii musculare violente
![Page 13: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/13.jpg)
![Page 14: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/14.jpg)
Lux antero-interna - Extracoracoidiana
- Subcoracoidiana
- Intracoracoidiana
- Subclaviculara
- Intratoracica
- Durere
- “pozitie umila”
- Umar “in epolet”
- Bratul apare scurtat, RE
- Cot in Abd
- Pa-lipsa capului din cav
glenoida
Lux posterioara - Subacromiala
- Subspinoasa
- Dureri accentuate
- Semne clinice sterse
- RI ireductibila
- Pa – cap sub unghiul
acromial
Lux antero-inferioara
(erecta)
- Brat in catarg, sustinut de
mana sanatoasa
Tb cautate lez neurovasculare!
![Page 15: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/15.jpg)
• Reducerea ortop de urgenta +/- anestezie iv
• Von arlt – pe scaun
• Hipocrate – calcai in axila
• Mothes - chinga in axila – tractiune cu membrul in abd 90
• Kocher – dec dorsal, tractiune, re, add, ri
• Milch – tract + abd + re + cap impins in glena
• Lux post – tract in abd +re
• Lux erecta – tract + add
• Rx ctrl + exam neurovascular
• Imob in esarfa/bandaj Dessault 2/3 sapt, urma de recup fct
• Tt chir -lux ireductibile, instab de umar, lez asoc
![Page 16: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/16.jpg)
• Structurile capsuloligamentare sunt
lezate intr-o progresie dinspre lat spre
med
![Page 17: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/17.jpg)
• Mecanism
• Instab postlaterala –
cadere pe mana intinsa cu
antebr in abd+sup
• Instab postmediala -cadere
pe mana in extensie ,
pronatie
• Instab anterioara
- lovit dir in cotul
flectat
![Page 18: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/18.jpg)
• Durere vie
• Deformare cot
• Impot fct totala
• Poz umila
• In lux post - antebratul pare mai mic, olecranul proemina sub
triceps
• In lux ant – nu se Pa olecranul in fosa
![Page 19: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/19.jpg)
• Reducere ortopedica
• Post – tract cu cot in flexie
• Ant – flexia treptata antebrat cu impingerea post a olecranului
+ 2 sapt atela de comfort
• Chirurgical
![Page 20: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/20.jpg)
• Luxatii radiocarpiene – rare
• Galeazzi – fr radius + lux RU
• Luxatii carpometacarpiene
![Page 21: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/21.jpg)
• Luxatii carpiene pure
- clasificate in functie de raportul cu
scafoidul
• Lux ant semilunar (posib
asoc cu fr.scafoid)
• Lux retro-lunata a carpului
• Lux transscafo-perilunata
• Luxatia retroscafolunata
![Page 22: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/22.jpg)
• Lux metacarpofalangiana II-V rara
• Lux metacarpofalangiana a policelui – afecteaza
prehensiunea
![Page 23: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/23.jpg)
• Mec de prod:
• Traum de energie inalta
Flexia coapsei pe bazin
• RI + ADD = lux post (dc traumatism dinapoi-inainte = lux post cu
fractura spranceana)
• RI + ABD = lux ant
• Dc coapsa in usoara flexie si abd, cu incarcare axiala = lux centrala
![Page 24: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/24.jpg)
• Dureri vii
• Impot fct totala
• Atitudine vicioasa
![Page 25: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/25.jpg)
- Mb inf – extensie aproape
completa, ADD, RI
- Capul femural se Pa in fosa iliaca
externa
- Marele trohanter ascensionat
- Scurtare 6-7 cm
- Misc de Abd si RE - imposibile
![Page 26: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/26.jpg)
- Mb inf in flexie 90grd, RI,
ADD
- Misc Abd si RE imposibile
- Capul F se Pa deasupra si
inapoia ischionului
- Scurtare 3-5cm
![Page 27: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/27.jpg)
- Mb inf – rect, RE, ABD acc
- Cap F se Pa sub arcada
femurala
- Scurtare 1-2 cm
- misc de ABD, RI imposibile
(8) – luxatia anterioara inalta
(9) – femurul este rotat extern
![Page 28: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/28.jpg)
- Mb. inf – flexie accentuata a coapsei, ABD, RE
- genunchiul se proiecteaza in afara iar pe fata
interna se evidentiaza clar coarda adductorilor
- mb inf alungit
- dureri si parestezii in partea sup si interna a
coapsei prin compresiunea n.obturator
![Page 29: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/29.jpg)
– de urgenta, frecventa complicatiilor tardive creste proportional cu intarzierea reducerii luxatiei
- pentru reducerea oricarei varietati de luxatie a soldului trebuie sa se imprime
capului femural un drum invers celui parcurs in cursul traumatismului
- reducerea se practica sub anestezie – generala sau rahidiana
- dupa reducerea luxatiei si controlul Rx se recomanda tractiune continua sau imobilizare in aparat gipsat 3-4 saptamani
! Luxatiile asociate cu fracturi de cotil
Metode de reduceri al luxatiilor – anterioare
- posterioare
![Page 30: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/30.jpg)
1. decubit dorsal
2. bazin imobilizat fixat apasand
pe spinele anterosuperioare
1. se flecteaza gamba pe coapsa la 90grd
2. Se flecteaza coapsa pe bazin la 90 grd,
3. Corectandu-se adductia si rotatia interna
- cand se simte capul femural sub acetabul se flexeaza si se
ridica genuchiul, se aude un zgomot de resort caracteristic
![Page 31: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/31.jpg)
1. In decubit dorsal se practica flexie maxima a soldului 2. abductie
3. rotatie externa 4. extensie graduala 5. rotatie in pozitie
normala
![Page 32: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/32.jpg)
1. pacient asezat in pronatie, cu partea terminala a mesei de reducere scoasa
2. membul neafectat sustinut de asistent
3. pelvisul fiind la marginea mesei
4. gamba este flectata pe coapsa si membrul inf este tinut de glezna in pozitie neutra
5. reducerea se obtine apasand pe capul femural,
6. Daca nu exista fractura de femur asociata , reducerea se obtine prin aplicarea unei presiuni pe partea superioara si
posterioara a gambei, imediat sub genunchi
![Page 33: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/33.jpg)
- pacientul in decubit dorsal cu bazinul fixat de asistent
1. Se flexeaza soldul
2. Se corecteaza abductia si rotatia externa convertindu-se in luxatie posterioara, apoi se ridica capul femural in
acetabul
![Page 34: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/34.jpg)
- se practica in cazurile dificile
- circumductia bazinului trece prin urmatoarele faze
1. sold flexie maxima
2. adductia soldului
3. rotatie interna
4. extensie
5. aducere in pozitia neutra
![Page 35: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/35.jpg)
• Imediate
- Disfunctie nv sciatic/obturator/peronier
- Comprimarea vaselor femurale
- Retentie de urina
- Fracturi – spranceana, acetabul, femur
• Tardive
- NACF
- Coxartroza
- Osificari posttraumatice heterotrope
- Sold instabil
- Luxatie inveterata
- Paralizia nv sciatic
- TEP
![Page 36: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/36.jpg)
Reducerea luxatiei de genunchi
Luxatie anterioara ! Asociate frecvent cu complicatii
vasculare/nervoase
• Simple
- anterioare
- posterioare
-Interne
-Externe
• mixte – anteroexterne/posteroexterne
![Page 37: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/37.jpg)
– Mb inf fixat la sol si corpul in miscare, forta traumatica actioneaza
a) la nivelul extremit inf a femurului anteroposterior, accentuand hiperextensia in recurvatum = lux ant
b) La nivelul extremit sup tibie = lux post
- Lux laterale- fortarea gambei in abd/add, cu genunchiul imobilizat in extensie
![Page 38: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/38.jpg)
• Dureri vii
• Impot fct totala
• Deformare evidenta genunchi
• Mb inf poate fi scurtat cu 2-6 cm
• In lux lat scurtarea este neinsemnata
• Piciorul se roteste de partea luxata
• Condilul tibial proemina
![Page 39: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/39.jpg)
• luxatia subastragaliana
• Luxatie tibioastragaliana
• Enuclearea astragalului
![Page 40: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/40.jpg)
![Page 41: = Modificarea permanenta a raporturilor dintre 2 suprafete ...seria7.weebly.com/uploads/4/0/8/5/4085189/10._luxatii_-_final.pdf · Reducerea – epifiza luxata parcurge traiectul](https://reader034.fdocument.pub/reader034/viewer/2022052319/5a76d0227f8b9a93088d6b56/html5/thumbnails/41.jpg)
• homolaterala
• incompleta
• divergenta