A joint dislocation is a condition in which the articular surface of the bones forming the joint is no longer anatomically in contact. The bones are literally out of its intended socket. A “subluxation” is a partial dislocation of the articulating surface and a more serious dislocation injury, traumatic dislocations are orthopedic emergencies because the associated joint structures, blood supply, and nerves are damaged and distorted and severely stressed. If the disc location injury is not treated promptly, avascular necrosis (tissue death resulting from anoxia and diminished blood supply) and nerve palsy have a high probability of occurring.
An injury caused by joint dislocation may be congenital in nature (present at birth e.g. developmental dysplasia of the hip), spontaneous or pathologic caused by a disease condition involving the articular or periarticular structures, or trauma resulting from an injury in which the joints are violently torn from its socket by a force strong such as those resulting from motor vehicle crashes or steep falls from a high ground.
Common signs and symptoms of a joint dislocation
Perhaps one of the most appreciated and universal signs of a traumatic joint dislocation include a combination of two or more of the following; obvious deformity, a change in the contour of the joint, change in the length of the affected extremity, loss of normal mobility, change in the axis of the dislocated bone, edema and acute pain within 2-3 hours after the injury. Normally, the most reliable diagnostic evaluation than would confirm a joint dislocation is an x-ray which can reveal any associated fracture surrounding the injured socket and underlying supporting structures.
Medical Management of a joint dislocation
The affected joint needs to be immobilized while the individual is transported to the nearest hospital or health care facility. The dislocation must be promptly reduced at the earliest possible time (i.e. displaced parts are brought into normal position) in order to preserve joint function and dysfunctional healing of the surrounding supporting structures of the joint. Analgesia, muscle relaxants and possibly mild form dosage of anesthesia are used to facilitate closed reduction (a nonsurgical or noninvasive reduction procedure to carefully place back the joint from its socket). The joint is carefully immobilized to prevent further injury as well as promote fast healing of the dislocated joint. Common immobilization materials used are bandages, splints, cast or traction devices in order to maintain proper alignment of a dislocated joint.
Nursing management for joint dislocation
Nursing care is integral in the speedy recovery of patients with joint related injuries and dislocations. Nursing management primarily involves supportive care such as providing comfort measures, evaluating the patient’s neurovascular status, and protecting the joint during the healing period. Neurovascular status in traumatic joint dislocation injury is vital to assess the individual’s
tolerance and response to the treatment. Generally after closed reduction is performed and once the joint is stable, gentle progressive, active and passive movement is initiated to help preserve adequate range of motion of extremities and restore strength. It is important to always support and provide ample rest periods in between exercise sessions.
The nurse is primarily charged with teaching the patient and his/her significant others on how to properly use immobilizing devices, how to protect a joint dislocation from further injury and how to properly use assistance or adaptive devices for carrying out activities of daily living.