Dislocation

In a dislocation of a joint, one of the bones which forms part of the joint be comes misplaced. The bones that form a joint are normally held in place by the fibrous "capsule" of the joint and by ligaments that span the joint. In a dislocation, the capsule and one or more ligaments are stretched or tom. It is often difficult to tell the difference between a dislocation and a fracture. In such a case, it is wise to treat the injury as though it were a fracture, awaiting the time when a physician can make an examination and treat the injury appropriately.

A. Dislocation of the Ankle. This is usually associated with fractures in the area. A severe injury here in which the parts of the joint are obviously out of place should be treated as a fracture. (See Fractures.) Treatment requires the services of a physician.

B. Dislocation of the Elbow. Dislocation here is usually caused by a twisting of the forearm or by a fall on the hand, resulting in great pain, inability to bend the elbow, and an obvious deformity.

WHAT TO DO
Obtain a physician's services as soon as possible. If the patient must be transported, the entire forearm should be secured to a splint with the elbow in as straight a position as possible.

C. Dislocation of the Finger. This impairment occurs in various injuries in which one of the joints is forced beyond its usual range of motion.

WHAT TO DO
This dislocation is one of the easiest to set. Using his two hands, the first-aider grasps the finger above and below the disabled joint. He then pulls steadily and firmly as though trying to make the finger longer. Thereupon the bones usually snap back into normal position.

D. Dislocation of the Hip. The ligaments holding the hip joint in place are strong, but dislocations do occur under great stress, as when the victim, in a fall, suddenly thrusts his weight on a foot or knee. This is a ball-and socket joint, and the head of the hip bone (femur) may move out of its socket in any of several directions. Because of the danger of further injury, any attempt by a first aider to set a dislocated hip is not recommended.

WHAT TO DO
1. Transport the victim to a hospital or physician's office.
2. If an ambulance is not available and a car must be used, strap the victim to a firm board, with a pillow beneath his knees.

E. Dislocation of the Jaw. A person may suffer dislocation of the jaw from opening his mouth widely, as in yawning, or from being struck on the chin while his mouth is open. Usually both right and left sides of the jaw are dislocated at the same time, a very painful injury leaving the victim unable to close his mouth.

WHAT TO DO
If the attempt to set a dislocated jaw proves successful, the jaw snaps back into normal position so quickly that the victim may bite the person helping him. Therefore, the attendant should wrap both his thumbs with several thicknesses of cloth and proceed as follows:
1. Resting both thumbs on the victim's lower molar teeth, one thumb on each side, exert steady pressure and, at the same time, lift the tip of the jaw with the third and fourth fingers.
2. Continue to exert this firm pressure as the victim attempts to relax his chewing muscles. Keep telling the victim, "Let me move your jaw."
3. As the operator feels the jaw moving into place, he should slip his thumbs sideways into the space between the patient's teeth and cheeks to avoid being bitten.
4. Once the jaw returns to normal, apply a wide bandage around the jaw and over the top of the head to give the jaw support while the stretched ligaments heal.

F. Dislocation of the Knee. Complete dislocation of the knee is unusual, caused only by major violence. In such severe injuries, the injured parts should be splinted and the victim transported to a hospital.
G. Dislocation of the Shoulder. This type of dislocation is caused by a fall on the shoulder or by the body's weight being thrust on the elbow or hand. One or more bones may also be fractured, and nerves or blood vessels in the vicinity may be damaged. It is preferable for a physician to set a dislocated shoulder. Because of the danger of fracture-dislocation, X-rays are usually taken.

WHAT TO DO
1. Arrange a sling for the injured arm.
2. Transport the victim to a hospital or a physician's office.

H. Dislocation of the Thumb. This injury is more serious than a dislocated finger, often requiring surgery. In any case a physician's services are usually needed.
I. Dislocation of a Toe. Correcting this injury, usually the result of a blow on the end of the toe, involves the same procedure as for setting a dislocated finger. (See preceding page.)

J. Dislocation of the Wrist. In the wrist joint the bones of the forearm and hand, as well as the bones of the wrist proper, combine to permit great flexibility. Dislocation of some of these bones is usually combined with tearing of the joint's ligaments and with bone fractures. A dislocation is recognized by comparing the victim's injured wrist with the other one.

WHAT TO DO
 1. Because this dislocation usually involves fractures, first aid treatment is the same as for fracture of the forearm. (See Fractures.)
2, A physician will decide, after X-ray examination, the best way to treat the injury.

Source
Modern Medical Guide
Harold Shryock, M.D