Dislocations and subluxations
Dislocations and subluxations: Excerpt from Handbook of Diseases
In a dislocation, joint bones are displaced so that their articulating surfaces totally lose contact. Subluxations partially displace the articulating surfaces.
Dislocations and subluxations occur at the joints of the shoulders, elbows, wrists, digits, hips, knees, ankles, and feet; the injury may accompany fractures of these joints or result in deposition of fracture fragments between joint surfaces. Prompt reduction can limit the resulting damage to soft tissue, nerves, and blood vessels.
Causes
A dislocation or subluxation may be congenital (as in congenital dislocation of the hip), or it may follow trauma or disease of surrounding joint tissues (for example, Paget’s disease). Gender also has an influence on injuries, especially of the knee (See Dislocations and subluxations in men and women, page 274.)
Signs and symptoms
Dislocations and subluxations produce deformity around the joint, change the length of the involved extremity, impair joint mobility, and cause point tenderness.
When the injury results from trauma, it’s extremely painful and commonly accompanies joint surface fractures. Even in the absence of concomitant fracture, the displaced bone may damage surrounding muscles, ligaments, nerves, and blood vessels and may cause bone necrosis, especially if reduction is delayed.
Diagnosis
Patient history, X-rays, and clinical examination rule out or confirm fracture.
Treatment
Immediate reduction (before tissue edema and muscle spasm make reduction difficult) can prevent additional tissue damage and vascular impairment.
Closed reduction consists of manual traction under general anesthesia (or local anesthesia and sedatives). During such reduction, I.V. morphine controls pain; I.V. midazolam controls muscle spasm and facilitates muscle stretching during traction.
Some injuries require open reduction under regional block or general anesthesia. Such surgery may include wire fixation of the joint, skeletal traction, and ligament repair.
After reduction, a splint, cast, or traction immobilizes the joint. Generally, immobilizing the digits for 2 weeks, hips for 6 to 8 weeks, and other dislocated joints for 3 to 6 weeks allows surrounding ligaments to heal.
Special considerations
❑ Until reduction immobilizes the dislocated joint, don’t attempt manipulation. Apply ice to ease pain and edema. Splint the extremity “as it lies,” even if the angle is awkward, unless there is loss of blood flow (no pulse, presence of pallor or cyanosis) distal to the injury.
Clinical tip Check for signs of vascular compromise; if present, emergency reduction is necessary. Signs include pallor, pain, loss of pulses, paralysis, and paresthesia.
❑ When a patient receives narcotics or benzodiazepines I.V., he may develop respiratory depression or arrest. Keep an airway and a hand-held resuscitation bag in the room, and monitor respirations and pulse rate closely.
❑ To avoid injury from a dressing that’s too tight, instruct the patient to report numbness, pain, cyanosis, or coldness of the extremity below the cast or splint.
❑ To avoid skin damage, watch for signs of pressure injury (pressure, pain, or soreness) both inside and outside the dressing.
❑ After removal of the cast or splint, inform the patient that he may gradually return to normal joint activity
❑ A dislocated hip needs immediate reduction. At discharge, stress the need for follow-up visits to detect aseptic femoral head necrosis from vascular damage.
Pictures
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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