Joint
Dislocations
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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