Untreated Dislocations: Immediate & Long-Term Complications, and Why Prompt Care is Crucial

What can happen if dislocations are left untreated?

Leaving a joint dislocation untreated can lead to a cascade of severe and often irreversible complications, ranging from acute nerve and blood vessel damage to chronic instability, severe osteoarthritis, and permanent loss of joint function.

Dislocations occur when the bones that form a joint are forced out of alignment, resulting in the complete separation of the joint surfaces. While common in areas like the shoulder, fingers, or kneecap, a dislocation is a serious injury that demands immediate medical attention. The longer a dislocated joint remains unreduced (not put back into its proper position), the higher the risk of significant, long-term damage to the surrounding structures and the joint itself.

Immediate Complications of Untreated Dislocations

When a joint dislocates, the forces involved are significant, and the misaligned bones can compress, stretch, or tear vital adjacent structures.

• Nerve Damage: One of the most critical immediate risks is damage to nerves running near the dislocated joint. The displaced bone can compress or stretch nerves, leading to:
  • Numbness or tingling (paresthesia) in the limb supplied by the affected nerve.
  • Weakness or paralysis of muscles innervated by the nerve.
  • In severe cases, permanent nerve damage can result in chronic pain, sensory deficits, or motor dysfunction.
• Blood Vessel Damage: Similarly, major arteries and veins can be compressed or torn by the displaced bones. This can lead to:
  • Ischemia: Reduced blood flow to the limb, potentially causing tissue death (gangrene) if not promptly resolved.
  • Compartment Syndrome: Swelling within a confined space (muscle compartment) that compresses nerves and blood vessels, leading to severe pain and potential permanent damage.
  • Internal bleeding from a torn vessel.
• Soft Tissue Damage: The ligaments, tendons, and joint capsule that stabilize the joint are stretched or torn during a dislocation. If not properly realigned, these tissues can:
  • Heal in a lengthened or incorrect position, leading to chronic instability.
  • Become trapped within the joint space, hindering proper reduction and causing further damage.
• Associated Fractures: The force causing the dislocation can also cause fractures. These can be:
  • Avulsion fractures: Where a ligament or tendon pulls a piece of bone away from its attachment site.
  • Impaction fractures: Where the ends of the bones are crushed against each other.
  • Leaving these untreated can lead to malunion (healing in a deformed position) or non-union (failure to heal), significantly complicating future treatment and joint function.
• Increased Pain and Swelling: While seemingly obvious, prolonged severe pain and swelling can make eventual reduction more difficult and increase the risk of further soft tissue damage during manipulation.

Long-Term Consequences of Untreated Dislocations

Beyond the immediate dangers, an unreduced dislocation sets the stage for a host of chronic and often debilitating problems.

• Chronic Joint Instability and Recurrent Dislocations: If the joint is not reduced, or if the supporting ligaments and capsule heal in a stretched or damaged state, the joint will remain unstable. This significantly increases the likelihood of future, often easier, re-dislocations, perpetuating a cycle of injury and damage.
• Joint Deformity and Malunion: Without proper realignment, the bones can begin to heal in their dislocated position. This leads to a permanent deformity of the joint, making future reduction extremely difficult or impossible without complex surgical intervention. The joint will then function abnormally, if at all.
• Osteoarthritis (Post-Traumatic Arthritis): The abnormal joint mechanics and chronic inflammation caused by an unreduced dislocation lead to accelerated wear and tear on the articular cartilage. This results in post-traumatic osteoarthritis, characterized by:
  • Progressive joint pain and stiffness.
  • Reduced range of motion.
  • Crepitus (grinding sensation).
  • Ultimately, severe joint degeneration that may require joint replacement surgery.
• Persistent Pain and Reduced Function: Chronic pain is a common consequence due to ongoing inflammation, nerve irritation, and abnormal joint loading. This pain, combined with the joint's instability and altered biomechanics, severely limits the ability to perform daily activities, work, or participate in physical recreation.
• Muscle Atrophy and Weakness: Disuse of the affected limb due to pain and instability, coupled with potential nerve damage, leads to significant muscle wasting (atrophy) and weakness, further compromising joint stability and function.
• Avascular Necrosis (AVN): In certain joints, particularly the hip, shoulder, or wrist (scaphoid bone), dislocation can disrupt the blood supply to one of the bone ends. If this blood supply is not quickly restored through reduction, the bone tissue can die, leading to collapse of the bone and severe joint destruction.
• Fibrosis and Scar Tissue Formation: Over time, the body attempts to "heal" the dislocated joint by forming dense scar tissue (fibrosis) around it. While this might seem beneficial, this scar tissue is often restrictive, permanently limiting the joint's range of motion and making any delayed reduction or surgical repair much more challenging.

Why Prompt Medical Attention is Crucial

The overwhelming evidence points to the necessity of immediate medical intervention for any suspected dislocation.

• Timely Reduction: The sooner a dislocated joint is reduced, the easier and safer the procedure typically is. Swelling and muscle spasms increase over time, making reduction more difficult and increasing the risk of further damage during the process.
• Accurate Diagnosis: Medical professionals can perform X-rays and other imaging studies to confirm the dislocation, rule out associated fractures, and assess the extent of soft tissue or neurovascular damage. This comprehensive assessment guides the appropriate treatment plan.
• Proper Post-Reduction Care and Rehabilitation: After reduction, the joint typically requires immobilization to allow damaged tissues to heal. This is followed by a structured rehabilitation program, guided by a physical therapist, to restore strength, stability, range of motion, and proprioception, significantly reducing the risk of chronic instability and re-dislocation.

Conclusion

A dislocated joint is more than just a bone out of place; it's a significant musculoskeletal injury with a high potential for severe and lasting complications if not addressed promptly. Leaving a dislocation untreated can transform an acute, manageable injury into a chronic, debilitating condition marked by persistent pain, instability, deformity, and severe osteoarthritis. For optimal outcomes and to preserve joint health and function, immediate medical evaluation and appropriate intervention are paramount.