Dislocation

Definition

A dislocation is a separation of two bones where they meet at a joint. (Joints are areas where two bones come together.) A dislocated bone is no longer in its normal position, which may result in damage to ligaments, nerves, and blood vessels.

Alternative Names

Joint dislocation

Considerations

It may be hard to tell a dislocated bone from a broken bone. Both are emergency situations and require the same first aid treatment.

Most dislocations can be treated in a physician's office or in the emergency room. You may be given medicine to make you sleepy. Sometimes general anesthesia in the operating room is needed.

Most dislocations, if treated early, will not result in permanent injury.

• Injuries to the surrounding ligaments generally take 3 - 6 weeks to heal. Sometimes, surgery to repair a torn ligament is needed.
• Injuries to nerves and blood vessels may result in more long-term or permanent problems.

Once a joint has been dislocated, it is more likely to happen again. Follow-up with an orthopedic surgeon is recommended after a dislocation.

Causes

Dislocations are usually caused by a sudden impact to the joint. This usually occurs following a blow, fall, or other trauma.

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

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.

First Aid

1. Call 911 before you begin treating someone who may have a dislocation, especially if the accident causing the injury may be life-threatening.
2. If there has been a serious injury, check the person's airway, breathing, and circulation. If necessary, begin rescue breathing, CPR, or bleeding control.
3. Do not move the person if you think that the head, back, or leg has been injured. Keep the person still. Provide reassurance.
4. If the skin is broken, take steps to prevent infection. Do not blow on the wound. Rinse the area gently to remove obvious dirt, but do not scrub or probe. Cover the area with sterile dressings before immobilizing the injury.
5. Splint or sling the injury in the position in which you found it. Do not move the joint. Be sure to immobilize the area above and below the injured joint.
6. Check the person's blood circulation around the injury by pressing firmly on the skin in the affected area. It should blanch white, then regain color within a couple of seconds. Avoid this step if the skin has been broken, to reduce the risk of infection.
7. Apply ice packs to ease pain and swelling.
8. Take steps to prevent shock. Unless there is a head, leg, or back injury, lay the victim flat, elevate the feet about 12 inches, and cover the person with a coat or blanket.

Do Not

• Do NOT move the person unless the injury has been completely immobilized.
• Do NOT move a person with an injured hip, pelvis, or upper leg unless it is absolutely necessary. If you are the only rescuer and the person must be moved, drag him or her by the clothing.
• Do NOT attempt to straighten a misshapen bone or joint or to change its position.
• Do NOT test a misshapen bone or joint for loss of function.
• Do NOT give the person anything by mouth.

Call immediately for emergency medical assistance if

Call 911 if the person has:

• A bone projecting through the skin
• A known or suspected dislocation or broken bone
• An area below the injured joint that is pale, cold, clammy, or blue
• Severe bleeding
• Signs of infection, such as warmth or redness at the injured site, pus, or a fever

Prevention

Preventing injuries in children:

• Create a safe environment around your home.
• Pay careful attention to preventing falls by gating stairways and keeping windows closed and locked.
• Supervise children carefully. There is no substitute for close supervision no matter how safe the environment or situation appears to be.
• Teach children how to be safe and look out for themselves.

Preventing dislocations in adults:

• Avoid falls by not standing on chairs, countertops, or other unstable objects.
• Eliminate throw rugs, especially for the elderly.
• Wear protective gear when participating in contact sports.

For all age groups:

• Keep a first aid kit handy.
• Remove electrical cords from floor surfaces.
• Use handrails on staircases.
• Use nonskid mats on the bottom of the bathtubs and avoid bath oils.

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References

Browner BD, Jupiter JB, Levine Am, Trafton PG, Krettek C., eds. Skeletal Trauma. 4th ed. Philadelphia, Pa: Saunders Elsevier;2008.

Chapman MW. Fracture healing and closed treatment of fractures and dislocations. In: Chapman MW, Szabo RM, Marder RA, Vince KG, Mann RA, Lane JM, et al, eds. Chapman's Orthopaedic Surgery. 3rd ed. Philadelphia, Pa: Lippincott, Williams & Wilkins: 2000:chap 10.

Foley KA. Knee dislocation. In: Rosen P, Barkin RM, Hayden SR, Schaider JJ, Wolfe R, eds. Rosen and Barkin's 5-Minute Emergency Medicine Consult. 3rd ed. Philadelphia, Pa: Lippincott, Williams & Wilkins; 2007.