A dislocation is a separation of two bones where they meet at a joint. (Joints are areas where two bones come together.) A dislocated bone is no longer in its normal position. A dislocation may also cause ligament or nerve damage.

It may be hard to tell a dislocated bone from a broken bone. Both are emergency situations and require the same first-aid treatment. Injuries to the surrounding ligaments generally take 3 to 6 weeks to heal.

Dislocations are usually caused by a sudden impact to the joint. This usually occurs following a blow, fall, or other trauma.

A dislocated joint may be:

• Visibly out-of-place, discolored, or misshapen
• Limited in movement
• Swollen or bruised
• Intensely painful, especially if you try to use the joint or bear weight on it

Nursemaid's elbow is a partial dislocation common in toddlers. The main symptom is refusal to use the arm. Nursemaid's elbow can be easily treated in a doctor's office without the following first aid steps.

1. Call 911 before you begin treating someone who may have a dislocation, especially if the accident causing the injury may be life-threatening.
2. If there has been a serious injury, check the person's airway, breathing, and circulation. If necessary, begin rescue breathing, CPR, or bleeding control.
3. Do not move the person if you think that his head, back, or leg has been injured. Keep the person still. Provide reassurance.
4. If the skin is broken, take steps to prevent infection. Do not blow on the wound. Rinse the area gently to remove obvious dirt, but do not scrub or probe. Cover the area with sterile dressings before immobilizing the injury.
5. Splint or sling the injury in the position in which you found it. Do not move the joint. Be sure to immobilize the area above and below the injured joint.
6. Check the person's blood circulation around the injury by pressing firmly on the skin in the affected area. It should blanch white, then regain color within a couple of seconds.
7. Apply ice packs to ease pain and swelling.
8. Take steps to prevent shock. Unless there is a head, leg, or back injury, lay the victim flat, elevate the feet about 12 inches, and cover the person with a coat or blanket.

• DO NOT move the person unless the injury has been completely immobilized.
• DO NOT move a person with an injured hip, pelvis, or upper leg unless it is absolutely necessary. If you are the only rescuer and the person must be moved, drag him or her by the clothing.
• DO NOT attempt to straighten a misshapen bone or joint or to change its position.
• DO NOT test a misshapen bone or joint for loss of function.
• DO NOT give the person anything by mouth.

Call 911 if the person has:

• A known or suspected dislocation or broken bone
• Severe bleeding
• An area below the injured joint that is pale, cold, clammy, or blue
• Signs of infection like warmth and redness at the injured site, pus, or a fever
• A bone projecting through the skin

Preventing injuries in children:

• Teach children how to be safe and look out for themselves.
• Create a safe environment around your home.
• Pay careful attention to preventing falls by gating stairways and keeping windows closed and locked.
• Supervise children carefully. There is no substitute for close supervision, no matter how safe the environment or situation appears to be.

Preventing dislocations in adults:

• Wear protective gear when participating in contact sports.
• Avoid falls by not standing on chairs, counter tops, or other unstable objects.
• Eliminate throw rugs, especially for the elderly.

For all age groups:

• Keep a first-aid kit handy.
• Use non-skid mats on the bottom of the bathtubs and avoid bath oils.
• Use handrails on staircases.
• Remove electrical cords from floor surfaces.

Browner, BD. Skeletal Trauma: Basic Science, Management, and Reconstruction. 3^rd Ed. Philadelphia, PA: Saunders; 2003:1629-1630.