Dislocations and subluxations
Dislocations and subluxations: Excerpt from Professional Guide to Diseases (Eighth Edition)
Dislocations displace joint bones so that their articulating surfaces totally lose contact; subluxations partially displace the articulating surfaces. (See Common dislocation.) Dislocations and subluxations occur at the joints of the shoulders, elbows, wrists, digits, hips, knees, ankles, and feet. These injuries may accompany joint fractures 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 hip dislocation) or it may follow trauma or disease of surrounding joint tissues.
Signs and symptoms
Dislocations and subluxations produce deformity around the joint, change the involved extremity’s length, 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 fractures, 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 a physical examination rule out or confirm a 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, a cast, or traction immobilizes the joint. In most cases, 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. Follow-up with a physical therapist is usually required to maintain optimal joint function.
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. If severe vascular compromise is present or is indicated by pallor, pain, loss of pulses, paralysis, or paresthesia, an immediate orthopedic examination (and possibly immediate reduction) is necessary.
❑ Because a patient who receives opioids or benzodiazepines I.V. may develop respiratory depression or arrest, keep an airway and a bag-valve-mask in the room. Monitor respirations and pulse rate closely. Also have opioids and benzodiazepine reversal agents readily available.
❑ 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 the cast or splint is removed, 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: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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