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Dislocation

A dislocation is a separation of two bones where they meet at a joint. Joints are areas where two bones come together.

A dislocated joint is a joint where the bones are no longer in their normal positions.

Alternative Names

Joint dislocation

Considerations

It may be hard to tell a dislocated joint from a broken bone . Both are emergencies. You will need the same first aid treatment.

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

When treated early, most dislocations do not cause permanent injury.

  • Injuries to the surrounding tissues generally take 6 to 12 weeks to heal. Sometimes, surgery to repair a ligament that tears when the joint is dislocated 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 put weight on it
  • Limited in movement
  • Swollen or bruised
  • Visibly out of place, discolored, or misshapen

Nursemaid's elbow is a partial dislocation that is common in toddlers. The main symptom is the child's 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 that caused the injury may be life-threatening.
  2. If the person has a serious injury, check their airway, breathing, and circulation. If necessary, begin rescue breathing , CPR , or bleeding control.
  3. Do not move the person if you think that their 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 any dirt you can see, but do not scrub or probe. Cover the area with sterile dressings before immobilizing the injured joint (see next step).
  5. Splint or sling the injured joint in the position in which you found it. Do not move the joint. Also immobilize the area above and below the injured area.
  6. Check the person's blood circulation around the injury by pressing firmly on the skin in the affected area. It should turn white, then regain color within a couple of seconds after you stop pressing on it. To reduce the risk of infection, do not do this step if the skin is broken.
  7. Apply ice packs to ease pain and swelling, but do not put ice directly on the skin. Wrap the ice in a clean cloth.
  8. Take steps to prevent shock . Unless there is a head, leg, or back injury, lay the victim flat, elevate their 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 them by their clothing.
  • Do NOT attempt to straighten a misshapen bone or joint or try to change its position.
  • Do NOT test a misshapen bone or joint for loss of function.
  • Do NOT give the person anything by mouth.

When to Contact a Medical Professional

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

To help prevent 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.

To help prevent dislocations in adults:

  • To avoid falls, do not stand on chairs, countertops, or other unstable objects.
  • Eliminate throw rugs, especially around the elderly.
  • Wear protective gear when participating in contact sports.

For all age groups:

  • Keep a first aid kit handy.
  • Remove electrical cords from floors.
  • Use handrails on staircases.
  • Use nonskid mats on the bottom of bathtubs and do not use bath oils.

References

Boss SE, Mehta A, Maddow C, Luber SD. Critical orthopedic skills and procedures. Emergency Medicine Clinics of North America. W.B. Saunders. Feb 2013;31(1).

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

Calandruccio JH. Fractures, dislocations, and ligamentous injuries. In: Canale ST, Beaty JH. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 67.

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.

Horn AE, Ufberg JW. Management of Common Dislocations. In: Roberts JR, Custalow CB, Thomsen TW, Hedges JR, eds. Roberts & Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 49.

Klimke A, Furin M. Prehospital Immobilization. In: Roberts JR, Hedges JR, eds. Roberts & Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 46.

Mascioli AA. Acute disclocations. In: Canale ST, Beaty JH. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 60.

Updated: 5/15/2014

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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