Dislocations are often very easily confounded with fractures; in fact, the two injuries are often inflicted at the same time. The chief distinguishing features of dislocations are, unnatural position of the limb, altered shape of the injured joint, and less than the natural degree of motion in the joint Pain and swelling, and more or less discoloration, are also usually found in the vicinity of the affected joint

The Treatment of Dislocations

The first thing to be accomplished is reduction of the dislocation, or returning of the bone to its natural position. This should be accomplished at as early a moment as possible, and can generally be done if attempted immediately after the accident without any very great difficulty, by simply pulling upon the limb in such a way as to draw the bone toward the socket at the same time manipulating the displaced end in such a way as to facilitate its return to its natural position. One of the great obstacles in the way of reducing a dislocation is the contraction of the muscles, which is in some degree involuntary, though in the greater part voluntary, as is shown by the fact that if the patient's attention is diverted, the muscles become relaxed and the process of reduction is greatly facilitated. This may generally be accomplished by asking the patient a question, or speaking to him in a rather loud and quick tone of voice just at the time the reduction is to be attempted. In very bad cases the use of chloroform or ether is necessary in order to cause the muscles to relax. In moderate cases, however, continuous and firm pulling upon the limb will, after a time, tire the muscles so that they will relax and allow the bone to return to its place. After the reduction has been accomplished, the limb should be kept perfectly quiet until the torn ligaments of the injured tissues shall have had time to heal. It is generally necessary to apply bandages to the pint, and sometimes a splint is required. When there is much pain, swelling, or inflammation, hot fomentations should be applied, or a hot shower or pour may be used. If hot applications increase the pain, cold or even ice compresses should be employed.

In some cases, alternate hot and cold applications give most relief. The drop bath, is very useful in many of these cases. A joint which has been injured by dislocation should be used very little for three or four weeks. If it becomes stiffened, hot fomentations and gentle manipulations will soon restore it to a useful condition. It should be recollected that a bone which has once been put cut of joint, is very liable to get out of joint again, and special care should be taken to protect it from any violence.

Dislocation of the Wrist

T his is a very rare displacement. It is indicated by an abnormal position of the hand and immobility of the wrist joint. All that is required is firm pulling upon the hand, which causes the displaced bones to slip into position.

Dislocation from Pulling the Arm

This is a form of dislocation which occurs in young children in consequence of being pulled forcibly by the arm. There is still some question among surgeons as to the exact nature of the dislocation, some claiming that the dislocation is at the wrist, and others at the elbow joint. It is probable that either joint may be affected. The hand will be found turned upon the palm, the patient being unable to turn it backward. All that is necessary is to grasp the hand and forcibly turn it upon the back, which will cause the bones to resume their proper position.

Dislocation of the Ankle

This accident is generally the result of jumping. In nearly all cases, more or less fracture of the ends of the leg bones also occurs. Dislocation of the ankle joint is always present in Pott's fracture, already described. The dislocation is easily reduced by pulling upon the foot and pressing the displaced bones into position. Properly prepared splints should be applied to keep the parts in position. Hot and cold applications should be made to prevent and relieve inflammation.