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WHAT  IS  A  JOINT  DISLOCATION?

 

Joint dislocation is the complete displacement of the two bones in a joint so that they are no longer in contact, usually as a result of injury. There may be recurrent dislocations and a strengthening operation may be needed.

Dislocation is usually accompanied by tearing of the joint ligaments and damage to the joint capsule (the membrane that surrounds the joint). It is the tearing that makes the injury so painful.

 

It most often occurs to the shoulder, thumb, finger, jaw and hip. Injury severe enough to cause dislocation can also cause one or both of the bones involved to break.

 

Joint dislocation is rare in children because they are very resilient. It takes a great deal of force, such as that caused by a road traffic accident, landing hard on concrete or a fall down the stairs, to remove a joint from its socket.

 

Joint dislocation, such as the one shown in this X-ray, occurs when the two bones in a joint are no longer in contact. This is usually caused by a severe fall or accident and is extremely painful.

 

Symptoms

 

Children are resilient, so your child will usually have had a nasty fall and normally hit the ground (or hard surface) with some force. Dislocation restricts or prevents the movement of the joint and is usually accompanied by severe pain.

 

• If a joint has dislocated, you will probably hear it click out of place. 
• The joint will look misshapen and swollen. 

Precautions

 

The most important thing .is not to move the injured child unless it is absolutely necessary.

 

• Do not give your child anything to eat or drink because a general anaesthetic will probably be required.
• Do not move your child until the injured part is secured and supported, especially if your child may have other injuries. He should be moved by trained rescue workers. You should move your child only if his life is in immediate danger.
• Do Hot try to replace a dislocated bone into its socket, 

Assessing the injury

 

A baby or toddler may be unable to tell you where it hurts so you will need to assess the injury. Look for the following signs:

 

• Difficulty in moving the limb normally or at all. For example, your child may not be able to stand or walk, or he may leave an arm dangling by his side. 
• Pain at or near the site of injury. This is made worse by movement. Sickening and severe pain often indicates dislocation (tenderness over a bone if it is slightly touched is a sign that the bone may be fractured). 
• A shortening, bending or twisting of the limb.
• A 'grating' sensation of bones rubbing together, pain, tenderness and a swelling of the injured part are signs and symptoms of both fractures and dislocations. If in any doubt, treat as a fracture. 

If your child has dislocated a bone he will be in immense pain and is unlikely to be able to move the injured limb at all. Seek urgent medical help

 

First aid for dislocations

 

Fractures, sprains, strains and dislocations may be hard to diagnose. For this reason, first-aid treatment of any of these conditions is handled as though the injury is a fracture.

 

• Assess the situation. Check your child's airway, breathing and circulation. If there is any blood loss, you must stop the flow of blood and treat him for shock. 
• Try your best to calm him down and keep him still. Stay close to him. The calmer he is, the less likely he is to move and cause further damage.
• Steady and support the injured part. For a shoulder dislocation, apply a sling or wrap a sheet around the body and arm to stabilize it. For the lower limbs, roll blankets and lay them around the leg. 
• Bandage the injured leg to the sound one. This is very important for babies and young children because thrashing about can cause further damage to the joint. Applying a cold pack to the affected area may reduce pain and swelling. 
• Talk to your child throughout to keep him calm. 
• Dial 966-2-690-5021 (Jeddah)  for an ambulance and stay with your child. 

To steady and support an injured arm, the shoulder needs to be stabilised. Applying a sling or wrapping a sheet around the body and arm can help to hold it in place.

 

IMPORTANT

• A person without medical qualifications should not attempt to put the joint back in place because of the risk of seriously damaging the nerves or worsening any fracture.
• You should aim to prevent movement at the injury site and arrange immediate removal of your child to hospital. 

Complications

 

In some cases, a dislocation is followed by potentially serious complications, but this is rare.

 

• Dislocation of the spinal vertebrae resulting from a severe back injury can damage the spinal cord, which can sometimes result in paralysis below the point of injury. 
• Dislocation of the shoulder or hip joint can sometimes damage nerves in the arm or the leg, which can again, in some cases, result in paralysis. 
• Occasionally, the tissue around a dislocated joint (usually the shoulder, although sometimes this can occur in the hip in children) so weakened that it cannot support the bone any more. Even after the joint has mended, minimal pressure can cause another dislocation. 

Congenital dislocation of the hip

 

Congenital dislocation of the hip (CHD) is a disorder present at birth in which the ball-like head of the femur (thigh bone) fails to fit into the cup-like socket of the pelvis to form a joint.

 

• The cause of congenital hip dislocation is unknown. However, it is usual for babies to move about freely in the uterus, which helps to mould their joints into shape. If the baby is in an awkward position, such as a breech, there may not be enough room for this process to take place properly. 
• Babies are checked at birth for CHD, but the condition is not always picked up at that time. They are then checked at intervals until they can walk. This is a routine physical examination of the hip to check for instability and the range of motion. 
• If the condition is found in early infancy, a special harness is usually used to man oeuvre the ball of the joint into the socket and keep it in position. Hip stabilization can take place in as little as a month, but sometimes harnesses need to be worn for longer. Most babies grow out of these problems and their hips develop normally. 

To cure a congenital dislocation of the hip, a special harness may be used to move the ball of the joint back into the socket.

 

For  More  Information:  Please  consult  your  physician  on  your  next  visit.