Medical Definition of Dislocation – An orthopedic nurse is a nurse who specializes in treating patients with bone, limb, or musculoskeletal disorders. Nonetheless, because orthopedics and trauma typically follow one another, head injuries and infected wounds are frequently treated by orthopedic nurses.
Ensuring that patients receive the proper pre-and post-operative care following surgery is the responsibility of an orthopedic nurse. They play a critical role in the effort to return patients to baseline before admission. Early detection of complications following surgery, including sepsis, compartment syndrome, and site infections, falls under the purview of orthopedic nurses.
Medical Definition of Dislocation
Dislocation means disruption of joint with total loss of contact between two articular surface.
[Ref-Adams, 11th edition, Page-79]
Or
Dislocation is defined as a total loss of contact between the two ends of bones.
[Ref-John Ebnezar’s “Textbook of Orthopedics” 4th edition page-28]
Or
Complete displacement of articular surfaces of a joint is called dislocation. adt of ymim betrobar
[Ref-Dr. M.A.H.M Jafar’s “Fractures and dislocations” 2nd edition, page-144]
Or
Dislocation is a complete and persistent displacement of a joint in which at least part of the supporting joint capsule and some of its ligaments are disrupted.
[Ref-BT.Basavanthappa “Orthopaedics for Nurses” 1″ edition page-23]
Or
A dislocation is a total disruption of a joint with no remaining contact between the articular surfaces i.e. complete displacement of articular surfaces of joint.
[Ref-Dr C M Enayet’s (Pintu) An aid to Short Practice of surgery, 6th edition, page-104]
Or
Dislocation means disruption of joint with total loss of contact between two articular surfaces.
[Ref-Dr. Redhwan’s “Royal Surgical Handicraft” 2nd edition, page-39]
Or
A dislocation is a displacement of one or more bones at a joint. Common joints which dislocate are shoulder, elbow, thumb finger and joint.
Definition subluxation :
A joint is subluxated when its articular surfaces are partly displace retain some contact one with the other.
Or
Subluxation is a partial dislocation of a joint.
Or
Subluxation is defined as partial loss of contact between the two ends of the bone.
[Ref-BT.Basavanthappa, “Orthopaedics for Nurses” 1st edition,page-21]
Types of dislocation:
A) Congenital dislocation:
1. Congenital dislocation of the hip (CDH).
B) Acquired dislocation:
1) Traumatic, common in young adults due to high-velocity trauma. E.g. RTA, Fall from height.
2) Pathological, e.g. TB hip, septic arthritis, etc.
3) Infective, e.g. Tom smith, arthritis in infants.
4) Paralytic: Poliomyelitis,cerebral palsy.
5) Inflammatory disorder: rheumatoid arthritis.
[Ref-John Ebnezar’s, Text Book of orthopedics, 4th edition, page-29]
A) History of patients: Patients give history of trauma, such as RTA, fall etc.
B) Symptoms:
1) Severe pain on injured site.
2) Inability to move the limb.
3) Swelling around the injury.
C) Signs:
1) Deformity of the limb. E.g. Shoulder dislocation-abduction deformity
2) Pain increase on movement.
3) Swelling become tender
4) Normal size and shape of the limb is change.
5) In case of shoulder dislocation patients support the injured hand by the
unaffected hand.
[Ref-John Ebnezar’s “Textbook of Orthopedics”, 4th edition, page-28]
First aid treatment of dislocated patient :
1. Keep the injured limb in comfortable position to reduce pain and swelling.
2. Ask patient to remain as still as possible.
3. Immobilize fracture/Dislocation,
a) Use broad bandages (where possible) to prevent movement at joints above and below the fracture:
✔ Support the limb, carefully passing bandages under the natural hollows of the body
✔ Place a padded splint along the injured limb
✔ Place padding between the splint and the natural contours of the body and secure firmly
✔For leg fracture, immobilise foot and ankle
✔ Check that bandages are not too tight (or too loose) every 15 minutes.
✔ Watch for signs of circulation loss to hands and feet
✔ Ensure an ambulance has been called – triple zero (000).
Notes on first aid:
✔Do not attempt to force a fracture or dislocation back into place – this could cause further injuries.
✔It can be difficult for a first aider to tell whether the injury is a fracture, dislocation, sprain or strain. If in doubt, always treat the injury as a fracture.
✔If collarbone is fractured, support arm on injured side in a St John sling.
✔If you suspect the joint is dislocated, rest, elevate and apply ice to the joint.
Treatment of dislocation: Dislocation is an orthopaedic emergency,
1. Immediate hospitalization.
2. Complete bed rest.
3. Reposition of the bone in the joint.
4. Immobilize the part by back slab, cast, and sling.
5. Closed reduction done by traction.
6. Open reduction when indicated.
7. Analgesics to reduce pain.
8. Check the X-ray of the injured limb after immobilization to see reposition of the bone in joint cavity
Complications of dislocation:
A. Acute complication:
1. Injury to peripheral nerves and vessels can occur, e.g. sciatic nerve palsy in posterior dislocation of hip.
B. Chronic complication:
1. Unreduced dislocation: This is common in Asian countries ignorance, delay in seeking treatment, etc.
2. Recurrent dislocations: Due to inadequate and improper healing tissues following initial trauma, e.g. recurrent dislocation shoulder.
3. Traumatic osteoarthritis: Due to damage to the articular cartilage following impaired nutrition by the synovial fluid.
4. Joint stiffness: Due to capsular and other soft tissue damage.
5. Avascular necrosis: Due to injury to the vessels.
6. Myositis ossifications: More commonly seen than in fractures greater periosteal strip.
[Ref-John Ebnezar’s “Textbook of Orthopedics” 4th edition, Page-29]
Difference between Fracture and Dislocation :
[Ref-Dr.Jahir, Surgery Part-1,4th edition,page-537]
Traumatic dislocation :
Traumatic dislocation is one where there is high velocity of force is required to push the joint out of its normal position.
(Ref-BT.Basavanthappa, “Orthopaedics for Nurses” 1″ edition,page-21)
Types of traumatic dislocation:
1. Fresh dislocation: Due to trauma there could be acute dislocation of a joint.
2. Chronic unreduced dislocation: Due to poverty, ignorance illiteracy patients could not take advantages of treatment.
3. Repeated dislocation: Due to some inherent instability and the other factors some joints are prone for repeated dislocation.
4. Fracture dislocation: here along with the dislocation a piece of neighbouring bone is avulsed from its position or totally broken depending upon the severity of injury.
[Ref-BT.Basavanthappa, “Orthopaedics for Nurses” 1″ edition,page-21]
Common traumatic dislocation:
| Areas involved | Types of dislocation |
| 1) Spine | Anterior C5 over C6 |
| 2) Upper Limb Acromioclavicular joint Sternoclavicular joint Shoulder joint Elbow joint Isolated dislocation of superior radio-ulnar joint. Fracture dislocation of superior radioulnar joint. Fracture head of radius and dislocation of inferior radioulnar joint. Wrist dislocation Kaplan injury | Type I/II/III Anterior/posteriorib Anterior /posterior Posterior Anterior Monteggia fracture Essex-Loprestifracture Perilunar, lunar Carpometacarpal joint of the thumb. |
| 3) Lower limb: Hip dislocation Knee dislocation Patella Ankle Foot | Anterior/Posterior/Central Posterior. Lateral dislocation. Anterolateral. Intertarsal/Tarsometatarsal |
[Ref-John Ebnezar’s “Textbook of Orthopedics” 4th edition, Page-29]
Kinds of deformities develop due to dislocation of joint :
Dislocation is an emergency :
1. It causes intense pain due to the stretching of the capsules. Unless reduced immediately, pain will not disappear.
2. Nourishment of the articular cartilages is through the synovial fluid which gets disturbed in a dislocation
3. Is greater chance of dislocation.
4. Injury to nerve and vessels.
[Ref-BT.Basavanthappa, “Orthopaedics for Nurses” 1″ edition, page-21]
Nursing care in joint dislocations:
In dislocations the role of an orthopedic nurse is mainly supportive in nature. The nursing care during the various stages of the treatment of dislocations is as follows:
1. Nursing care before reduction of the dislocated joint: Most of dislocations require closed reduction under general anaesthesia, preparation and the procedures of the nursing care are the same as for other preoperative nursing care.
2. Nursing care after reduction of the dislocation: Once the reduction of dislocation is carried out, the limb has to be immobilized in a plaster of i slab or cast and a sling is given in cases of dislocations involving the limbs. The nursing care in these situations is the same as described for slab or cast.
3. Nursing care during follow-up: This is the same as described for the follow up treatment of plaster slab or cast.
[Ref-BT.Basavanthappa, “Orthopaedics for Nurses” 1″ edition]
Commonly affected joints in dislocation:
1) Shoulder joint.
2) Hip joint.
3) Knee joint.
4) Elbow joint.
5) Wrist
[Ref-Dr. Jahir’s “Surgery 1″ Paper”, 4th edition, Page-5371]
Causes of pathological dislocation:
1) Anterior poliomyelitis: Due to muscular weakness and imbalance, joint becomes flail as a result dislocation occurs hip and shoulder are commonly affected.
2) Cerebral palsy: Due to hypertonicity and excessive spasm of muscles, dislocations occur specially in
small joints of hand and foot.
3) Infection of joint: Pyogenic, Tuberculous, Gonococcal and Syphilitic infection.
4) Rheumatoid arthritis: In late stage of rheumatoid arthritis when clawing of fingers and toes
develop may lead to dislocation or subluxation of interphalangeal or metacarpo-phalangeal joints.
5) Destructive osteoarthritis due to previous injury of the joint usually in vertebral column e.g. spondyliothesis.
6) Neruopathic arthritis (Charcot’s joint): In this condition joint becoi denervated (painless), disorganised and flail due to destruction of bone and soft tissues around the joint.
[Ref-Dr. M.A.H.M Jafar’s “Fractures and dislocations” 2nd edition page-14]
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