First aid for Dislocations
What is a dislocation?
Dislocation refers to the displacement of the bones that form a joint. Often resulting from trauma, dislocations and subluxations are caused when adjoining bones no longer touch each other, a partial or incomplete dislocation is called a subluxation.
Dislocations and subluxations usually occur at joints that are inherently less stable. The more closely bones fit together, and the greater the stability (afforded by the ligaments, muscles and joint capsule), the greater the force required to result in dislocation.
In a healthy joint, the bones are normally held together with fibrous bands called ligaments. These ligaments are attached to each bone along with a fibrous sac surrounding the joint called the articular capsule or joint capsule.
The ligaments and joint capsule are relatively strong and non-elastic but allow movement within normal limits for each particular joint.
In the event of a dislocation, one of the bones making up the joint is forced out of its natural alignment from excessive stretching and tearing of the joint ligaments and capsule. Muscles and tendons surrounding the joint are usually stretched and injured to some degree.
A violent movement at the joint that exceeds normal limits usually causes a dislocation. Although dislocations often result from trauma, dislocations sometimes occur as a result of disease affecting the joint structures. Following a dislocation, the bones affected are often immobile and the affected limb may be locked in an abnormal position. In severe dislocations there is also a high risk of fractures, in extremely violent instances the ligaments and supporting structures can also tear small chips off the bone.
What are the signs and symptoms of a dislocation?
In addition to the physical signs and symptoms, the history will also suggest a dislocation, for example the patient experiencing a recent fall followed by a reduced range of movement in a particular joint. In the majority of cases, the affected joint will swell significantly and feel painful, especially if pressure is applied.
Some dislocations, especially those in patients who have experienced numerous recurrent dislocations at the same joint, may present with mild pain due to the laxness of the muscles and supporting tissues.
The chance of a patient dislocating their joint again is primarily related to their age, for example, young people (less than 20) have a very high rate of re-dislocating their shoulder – 90 per cent or higher. The older the patient gets, the less chance there is of re-dislocating.
Symptoms of dislocations and subluxations may include:
- pain in the injured area;
- swelling in the injured area;
- difficulty using or moving the injured area in a normal manner;
- deformity of the dislocated area; and
- warmth, bruising, or redness in the injured area.
In the majority of cases, swelling associated with dislocations are minimal due to the fact that joints have very limited blood supply. An exception to this is the patella (kneecap), where the close proximity of the popliteal artery and the strong attachments of this blood vessel to the femur and tibia make it vulnerable to damage.
What is the first aid for a dislocation?
Management of a dislocation is after managing all life and limb-threatening conditions. A first-time dislocation should be considered and treated as a possible fracture.
As a general rule, suspected dislocations should be splinted in the position found. Remember that the patient may be experiencing high levels of pain and pain relief is an important consideration, especially before moving the patient.
Any splint that is available should be used to splint the injury in the position found. Splints can include:
- the patient supporting the limb in a comfortable position;
- triangular bandages and frac straps;
- rigid splints such as box splints;
A description of the history of the event, the dislocation and the presence of pulses, movement, sensation and colour before and after splinting should be handed over to receiving medical staff and recorded on the paperwork.
It may be hard to tell a dislocated bone from a broken bone. Both are emergency situations and require the same first-aid treatment. Injuries to the surrounding ligaments generally take 3 to 6 weeks to heal.
Dislocations are generally uncommon in younger children because their growth plates (area of bone growth located in the ends of long bones) are weaker than the muscles or tendons and, as a result, are more prone to fractures than dislocations.
Dislocations should be immobilised and patients transported with suitable pain relief, in the majority of cases, dislocations will require an X-ray to eliminate any fractures before reduction of the dislocation.