Traumatic joint dislocation means dislocation of joints due to injury or violence. Dislocations are often caused by sudden trauma on the joint like an impact or fall. Treatment for joint dislocation includes skilled manipulation to return the bones to their normal position and this manipulation should be done by the skilled persons only.

A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. A partial dislocation is referred to as a subluxation. Dislocations are often caused by sudden trauma on the joint like an impact or fall. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Dislocations can occur in any joint major (shoulder, knees, etc.) or minor (toes, fingers, etc). The most common joint dislocation is a shoulder dislocation.

Treatment for joint dislocation is usually by closed reduction, that is, skilled manipulation to return the bones to their normal position. Reduction should only be performed by trained medical professionals, because it can cause injury to soft tissue and/or the nerves and vascular structures around the dislocation.

Symptoms

The following symptoms are common with any type of dislocation.

•           Intense pain

•           Joint instability

•           Deformity of the joint area

•           Reduced muscle strength

•           Bruising or redness of joint area

•           Difficulty moving joint

•           Stiffness

Causes

Joint dislocations are caused by trauma to the joint or when an individual falls on a specific joint. Great and sudden force applied, by either a blow or fall, to the joint can cause the bones in the joint to be displaced or dislocated from normal position.With each dislocation, the ligaments keeping the bones fixed in the correct position can be damaged or loosened, making it easier for the joint to be dislocated in the future.

Some individuals are prone to dislocations due to congenital conditions, such as hypermobility syndrome and Ehlers-Danlos Syndrome. Hypermobility syndrome is genetically inherited disorder that is thought to affect the encoding of the connective tissue protein’s collagen in the ligament of joints. The loosened or stretched ligaments in the joint provide little stability and allow for the joint to be easily dislocated.

Diagnosis

Initial evaluation of a suspected joint dislocation should begin with a thorough patient history, including mechanism of injury, and physical examination. Special attention should be focused on the neurovascular exam both before and after reduction, as injury to these structures may occur during the injury or during the reduction process. Subsequent imaging studies are frequently obtained to assist with diagnosis.

1. Standard plain radiographs, usually a minimum of 2 views

• Generally, pre- and post-reduction X-rays are recommended. Initial X-ray can confirm the diagnosis as well as evaluate for any concomitant fractures. Post-reduction radiographs confirm successful reduction alignment and can exclude any other bony injuries that may have been caused during the reduction procedure.
• In certain instances if initial X-rays are normal but injury is suspected, there is possible benefit of stress/weight-bearing views to further assess for disruption of ligamentous structures and/or need for surgical intervention. This may be utilized with AC joint separations.
• Nomenclature: Joint dislocations are named based on the distal component in relation to the proximal one.

2. Ultrasound    

• Ultrasound may be useful in an acute setting, particularly with suspected shoulder dislocations. Although it may not be as accurate in detecting any associated fractures, in one observational study ultrasonography identified 100% of shoulder dislocations, and was 100% sensitive in identifying successful reduction when compared to plain radiographs. Ultrasound may also have utility in diagnosing AC joint dislocations.
• In infants <6 months of age with suspected developmental dysplasia of the hip (congenital hip dislocation), ultrasound is the imaging study of choice as the proximal femoral epiphysis has not significantly ossified at this age.

3. Cross-sectional imaging (CT or MRI)

• Plain films are generally sufficient in making a joint dislocation diagnosis. However, cross-sectional imaging can subsequently be used to better define and evaluate abnormalities that may be missed or not clearly seen on plain X-rays. CT is useful in further analyzing any bony aberrations, and CT angiogram may be utilized if vascular injury is suspected. In addition to improved visualization of bony abnormalities, MRI permits for a more detailed inspection of the joint-supporting structures in order to assess for ligamentous and other soft tissue injury.

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John George
Journal of Trauma and Orthopedic Nursing
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