Joint Dislocation in Children: Causes, Symptoms, and Treatment

What is dislocation of joint in child?

A joint dislocation in a child occurs when the bones that form a joint are forced out of their normal alignment, causing the articulating surfaces to separate completely. This is a serious injury that can affect various joints, often due to falls, sports injuries, or specific mechanisms of force unique to the pediatric population.

Understanding Joint Dislocation

A joint is formed where two or more bones meet, typically allowing movement. These bones are held together by a complex network of ligaments, tendons, and muscles, and their articulating surfaces are covered with cartilage, enclosed within a joint capsule containing synovial fluid. A dislocation, also known as luxation, signifies a complete disruption of the normal anatomical relationship between the bones forming a joint. This differs from a subluxation, which is a partial dislocation where the joint surfaces are still partially in contact.

In a child, the skeletal system is still developing, making them uniquely susceptible to certain types of dislocations and requiring specific considerations for diagnosis and treatment.

Why Children Are Susceptible

Children's musculoskeletal systems differ significantly from adults', contributing to their vulnerability to joint dislocations:

• Ligamentous Laxity: Children often have more flexible and elastic ligaments compared to adults. While this can sometimes protect against bone fractures (as the ligament may stretch rather than the bone breaking), it can also allow for greater joint mobility, potentially leading to dislocation under certain forces.
• Open Epiphyseal Growth Plates: The ends of long bones in children contain epiphyseal growth plates, which are areas of cartilage where bone growth occurs. These growth plates are weaker than the surrounding bone or ligaments and can be mistaken for a fracture or dislocation on X-rays if not properly interpreted. In some cases, a severe force might cause a growth plate injury that mimics a dislocation.
• Immature Motor Skills and Coordination: Younger children, in particular, have developing balance and coordination, making them more prone to falls and accidental injuries during play or sports.
• Playful Activities and Risk-Taking: Children engage in active play, often involving jumping, climbing, and running, which inherently carries a risk of falls and impacts.

Common Joints Affected in Children

While any joint can dislocate, some are more commonly affected in children due to specific mechanisms of injury or anatomical factors:

• Elbow (Nursemaid's Elbow): This is perhaps the most common joint dislocation in young children (typically under 5 years old). It's a radial head subluxation, meaning the radius bone at the elbow partially slips out of its ligamentous ring (the annular ligament). It's often caused by a sudden pull on the child's outstretched arm, such as when lifting a child by one arm, swinging them by their hands, or catching them from a fall. The child will typically refuse to use the arm, holding it close to their body, often with the palm turned inward.
• Shoulder: The shoulder is the most mobile joint in the body, making it susceptible to dislocation in both children and adults. In children, it often results from falls onto an outstretched arm, direct blows to the shoulder, or sports injuries (e.g., gymnastics, football).
• Fingers and Toes: These small joints can dislocate due to direct impact (e.g., catching a ball improperly), falls, or jamming injuries.
• Hip: Hip dislocations are less common in children but are serious injuries, often resulting from high-impact trauma like car accidents or severe falls. They can also occur in children with underlying conditions like hip dysplasia.
• Patella (Kneecap): The kneecap can dislocate, usually moving to the outside of the knee. This is more common in adolescent girls, often during sports activities involving twisting or pivoting movements, or due to anatomical predispositions.

Signs and Symptoms of a Dislocated Joint

Recognizing the signs of a dislocated joint is crucial for prompt medical attention. Common indicators include:

• Severe Pain: Often immediate and intense at the site of the injury.
• Visible Deformity: The joint may look out of place, crooked, swollen, or misshapen.
• Swelling and Bruising: Accumulation of fluid and blood around the injured joint.
• Inability to Move: The child will likely be unable to move the affected joint or limb, or movement will be extremely painful.
• Numbness or Tingling: In some cases, nerve compression can occur, leading to altered sensation below the injury.
• Loss of Function: The limb may feel weak or unstable.
• Child's Behavior: Young children may cry inconsolably, refuse to use the injured limb, or guard it protectively.

What to Do If You Suspect a Dislocation

If you suspect a child has dislocated a joint, immediate action is necessary:

• Remain Calm and Reassure the Child: Your calm demeanor can help reduce the child's anxiety.
• Do Not Attempt to Reduce the Dislocation: Never try to "pop" the joint back into place yourself. This can cause further damage to ligaments, blood vessels, nerves, or growth plates.
• Immobilize the Joint: Gently support the injured limb in the position it was found. You can use a sling for an arm injury or a makeshift splint for a leg or finger if necessary to prevent movement.
• Apply Ice: Apply a cold pack wrapped in a cloth to the injured area for 15-20 minutes at a time to help reduce swelling and pain.
• Seek Immediate Medical Attention: Transport the child to an emergency room or urgent care clinic promptly.

Medical Diagnosis and Treatment

Upon arrival at a medical facility, healthcare professionals will:

• Physical Examination: Assess the joint for deformity, swelling, tenderness, and neurovascular status (checking for nerve and blood vessel compromise).
• Imaging Studies: X-rays are typically performed to confirm the dislocation, rule out associated fractures (especially growth plate injuries), and ensure no bone fragments are present within the joint. In some cases, an MRI or CT scan may be used for more detailed soft tissue or complex bone assessment.
• Reduction: The primary treatment for a dislocation is reduction, which is the process of gently manipulating the bones back into their correct anatomical alignment. This is usually performed by a trained medical professional (e.g., orthopedic surgeon, emergency physician) and often requires pain medication, sedation, or even general anesthesia to relax the muscles and minimize pain.
• Immobilization: After reduction, the joint is typically immobilized using a sling, cast, or brace for a period (e.g., 2-6 weeks) to allow the joint capsule and ligaments to heal and prevent re-dislocation.
• Rehabilitation: Once the immobilization period is over, physical therapy or occupational therapy is often recommended. This helps restore range of motion, strength, and stability to the affected joint, reducing the risk of future dislocations.

Potential Complications

While most dislocations heal well with proper treatment, potential complications can include:

• Recurrent Dislocations: Especially common in the shoulder, where the joint capsule and ligaments may stretch, making future dislocations more likely.
• Nerve or Blood Vessel Damage: Although rare, severe dislocations can compress or damage adjacent nerves or blood vessels.
• Arthritis: Long-term damage to the joint cartilage can increase the risk of developing osteoarthritis later in life.
• Growth Plate Injury: Dislocation-related trauma near a growth plate could potentially affect bone growth, though this is rare.
• Chronic Pain or Instability: If not properly rehabilitated, the joint may remain unstable or painful.

Prevention Strategies

While not all dislocations can be prevented, several strategies can reduce the risk in children:

• Safe Play Practices: Supervise children during play, especially on playgrounds or during activities with a high risk of falls.
• Proper Lifting Techniques: Avoid lifting or swinging young children by their arms. Instead, lift them by their torso or under their armpits.
• Sports Safety: Ensure children wear appropriate protective gear for sports and receive proper coaching on techniques to minimize injury risk.
• Home Safety: Secure furniture, use safety gates, and remove tripping hazards to prevent falls.
• Awareness of Child Development: Understand a child's physical capabilities and limitations based on their age and developmental stage.

Conclusion

Joint dislocations in children are significant injuries that require prompt and appropriate medical attention. Understanding the unique anatomical considerations in pediatric patients, recognizing the signs, and knowing the correct first aid steps are vital for parents, caregivers, and fitness professionals. With proper diagnosis, reduction, immobilization, and rehabilitation, most children recover fully, returning to their active lives with restored joint function.