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A dislocation of a joint is a condition in which the articular sur-faces of the bones forming the joint are no longer in anatomic contact. The bones are literally “out of joint.” A subluxation is a partial dislocation of the articulating surfaces. Traumatic dislo-cations are orthopedic emergencies because the associated joint structures, blood supply, and nerves are distorted and severely stressed. If the dislocation is not treated promptly, avascular ne-crosis (tissue death due to anoxia and diminished blood supply)and nerve palsy may occur.
Dislocations may be congenital, or present at birth (most often the hip); spontaneous or pathologic, caused by disease of the articular or periarticular structures; or traumatic, resulting from injury in which the joint is disrupted by force.
Signs and symptoms of a traumatic dislocation are pain, change in contour of the joint, change in the length of the ex-tremity, loss of normal mobility, and change in the axis of the dislocated bones. X-rays confirm the diagnosis and demonstrate any associated fracture.
The affected joint needs to be immobilized while the patient is transported to the hospital. The dislocation is promptly reduced (ie, displaced parts are brought into normal position) to preserve joint function. Analgesia, muscle relaxants, and possibly anesthe-sia are used to facilitate closed reduction. The joint is immobilized by bandages, splints, casts, or traction and is maintained in a sta-ble position. Neurovascular status is monitored. After reduction, if the joint is stable, gentle, progressive, active and passive move-ment is begun to preserve range of motion (ROM) and restore strength. The joint is supported between exercise sessions.
Nursing care is directed at providing comfort, evaluating the pa-tient’s neurovascular status, and protecting the joint during heal-ing. The nurse teaches the patient how to manage the immobilizing devices and how to protect the joint from reinjury.
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