Orthopedic Injuries: Dislocations

A dislocation usually occurs when the ligaments (the bands of fibrous tissue that connect bones at the joints) stretch or tear under a blow or a hard pull to the limb. In a partial dislocation (subluxation), the bone is pulled out of alignment but the bone ends meeting at the joint still touch. In a complete dislocation (luxation), the bones no longer meet properly.

Partial dislocations of the shoulder or elbow (nursemaid's elbow) are sometimes caused accidently when adults yank too hard on the child's hand while walking or playing, or when swinging the child by the arms. This usually occurs in children aged two to five. There may or may not be an audible snap, but the child will feel pain in the joint, which can be relieved in minutes when a physician realigns the bone.

Another common childhood dislocation is a sideways luxation or subluxation of the knee cap. It causes knee pain when running, going up or down steps or darting sideways. Dislocations may also occur in the joints of the fingers or thumb when the digits are jammed during ball playing or falling.

Hip dislocations may occur during a major trauma but more often are present at birth, especially in breech infants and in those delivered through cesarean section. A congenital hip dislocation is not always detected at birth, but may become apparent when the child attempts to crawl and walk.

Sometimes dislocated bones slip back into place on their own, and other times they need to be realigned by a physician. Either way, dislocations require medical care because they often stretch or tear muscles and may damage joints.

SIGNS OF A DISLOCATION

• A joint that appears abnormal or misaligned.

• Joint pain, usually severe enough to prompt the child to avoid moving the injured part.

• Joint stiffness and swelling.

• Abnormal gait or posture.

HOW TO GIVE FIRST AID FOR A DISLOCATION

• DO NOT attempt to move the limb or "pop" the bone back into its socket yourself.

• If possible, immobilize the joint with a splint, sling or both. (See Fractures for instructions.)

• Apply an ice pack to the joint, using cloth or a large bandage to protect the skin.

• If possible, elevate the affected joint.

• Take the child to a doctor or hospital emergency room. Even if the bone end has slipped back into its proper place, there may be an injury that requires treatment.

• After the bone is back in its proper place, the child should rest the dislocated limb to permit normal healing.

HELPFUL TIPS

• Do not pick up children by the hands or yank their arms with force.

• Avoid swinging a child by the arms, especially if he has had a previous dislocation of the shoulders or elbows.

• Make sure a doctor checks an infant for a possible congenital hip dislocation at birth and monitors the hips before the baby is old enough to crawl or stand.

• If a child has recurrent dislocation of the knee cap, ask your doctor about exercises to strengthen the muscles that keep the knee cap in its proper place.

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Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.