JOINT DISLOCATION (MEDSURG 17) Flashcards
an injury to a joint, a place where two or more bones come together, in which the ends of the bones are forced from their normal positions. This painful injury temporarily deforms and immobilizes the joint.
JOINT DISLOCATION
Dislocation is most common in
_________. Other sites include
elbows, knees and hips.
Shoulders and fingers
It is complete or persistent displacement of a
joint in which at least part of the supporting joint capsule and some of its ligaments are disrupted
Joint dislocation
An injury where a joint is forced out of normal position. Joints can be dislocated from injury. This usually happen from a fall, motor vehicle accident or participation in sports.
Joint dislocation
CAUSES OF DISLOCATION
May occur in any situation, whether it being the
sporting arena or routine daily chores.
● Trauma, falls or motor vehicle accidents
● Underlying pathological condition such as TB,
inflammatory disorders.
● Adults are more prone to dislocation than
children.
● Previous joint dislocation result in weakening of
tendons, ligament and muscle which may be a
cause of recurrent dislocations.
6 TYPES OF DISLOCATIONS (CATPIP)
Congenital
Acquired
Paralytic Poliomyelitis, cerebral palsy.
Inflammatory disorders rheumatoid arthritis.
Pathological e.g. TB Hip, Septic arthiritis
SIGN of JOINT DISLOCATION
Swelling
● Tenderness
● Warmth, bruising or redness.
● Deformities that may be sign of
dislocation:
o Shoulder abduction deformity
o Elbow flexion deformity
Hip anterior- flexion, abduction and
internal rotation deformity
o Hip posterior- flexion, adduction and
internal rotation deformity
o Knee flexion deformity
o Ankle varus deformity
SYMPTOMS
Severe pain
● Joint locked in one position
● Difficulty using or moving the joint
● Loss of sensation
● Weakness
Examination
Look feel move
DIAGNOSTIC EVALUATIONS
Xray
MRI
CT SCAN
radiograph of
the affected part
should include anterior
posterior and lateral
views and sometimes
special view may be
needed. It is used to
produce image of
internal tissues, bones
and organs onto film.
Xray
a diagnostic procedure that uses a
combination of large magnets,
radiofrequencies and a computer to produce
more detailed and precise image of
structures within the body than X-ray.
MRI
COMPLICATIONS
Acute injury to peripheral nerve and vessels
2) Chronic:
o Unreduced dislocation
o Recurrent dislocation
o Traumatic osteoarthritis
o Joint stiffness
o Avascular necrosis
o Myositis ossificans
MANAGEMENT
●FIRST AID
●REDUCTION:
➢Closed reduction
➢Open reduction
●NURSING MANAGEMENT
PRINCIPLES OF MANAGEMENT
Acute dislocation should be reduced as soon as
possible.
● OPEN REDUCTION is rarely necessary for acute
dislocation.
● CLOSE REDUCTION with intravenous analgesia
and sedation or under GA (general anaesthesia)
should be attempted first for most uncomplicated
INITIAL FIRST AID MANAGEMENT (STOP)
S: (Stop) Immediately immobilize the patients
dislocated joint as there may be strong positivity of
fracture.
➢ T: (Talk), ask the questions if the patient is
conscious
➢ O: Observe closely for any injury, swelling,
deformity or bleeding.
➢ P: Prevent further injury to the patient by
conducting a whole body assessment.
INITIAL FIRST AID MANAGEMENT (RICE)
➢ R: (Rest) sit or lie the patient down in
comfortable position.
➢ I: (Ice) use cold packs to cool compress the
affected area
➢ C: (Compression) wrap the compression
bandage around the limb to support it and
restrict movement.
➢ E: (Elevate) the injured limb should be
supported above the level of the heart
If patient is unconscious then follow: (CABD)
C: (Compression) initiate CPR
A: (Airway) ensure airway is clear by jaw thrust,
chin lift head tilt maneuver
B: (Breathing) listen and feel the signs of life.
D: (Defibrillator) perform defibrillation if CPR fails
2 TYPES OF REDUCTION
Closed reduction
Open reduction
CLOSED REDUCTION TECHNIQUES
Stimson’s gravity technique
Kocher’s technique
OPEN REDUCTION
Operative reduction
When to use open reduction
When close reduction failed
There is articular fragment that needs accurate position
Avulsion fracture
When there is associated injuries such as arterial damage
reduction AFTER CARE
To promote healing after closed or open reduction doctor may recommend:
Splint/Cast:
Medications for pain control
Traction
immobilizes the dislocated area to
promote alignment. promote alignment.
Splint/Cast:
Ibuprofen, Naproxen,
Acetaminophen is a medication used in reduction for
Pain control
the application of a force to stretch certain
part of body in certain direction. It consists of pulley, strings, weights, metal frame attached over or on the bed.
Traction
In the first days of retraction, how many hours does ice pack need to be used
24 to 72 hours
What is the position when traction is used to stabilize lower limb fractures.
Supine
Diet for JD
high in proteins, carbohydrates,
vitamins, and minerals.
And Increase the amount of roughage or fiber in the diet. Limit gas-forming foods.
