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Fracture-Dislocation: Causes, Symptoms & Treatment

A fracture-dislocation is a combined injury involving both a broken bone and a dislocated joint. It typically results from severe trauma and requires prompt medical treatment.

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Things worth knowing about "Fracture-Dislocation"

A fracture-dislocation is a combined injury involving both a broken bone and a dislocated joint. It typically results from severe trauma and requires prompt medical treatment.

What is a Fracture-Dislocation?

A fracture-dislocation is a serious orthopaedic injury in which a bone fracture and a joint dislocation occur simultaneously at the same anatomical site. Because both the bone and the surrounding joint structures -- including ligaments, the joint capsule, and cartilage -- are damaged at the same time, this type of injury is considered more complex and severe than either a fracture or a dislocation alone. Fracture-dislocations can affect many joints in the body, but are most commonly seen at the shoulder, elbow, hip, knee, and ankle.

Causes

Fracture-dislocations are typically caused by high-energy trauma. Common causes include:

Road traffic accidents (e.g., motorcycle or car collisions)
Falls from a significant height
Sports injuries (e.g., skiing, contact sports, or martial arts)
Direct blows or crushing injuries
Falls onto an outstretched hand or leg

In some cases, pre-existing bone conditions such as osteoporosis may lower the threshold for injury, meaning a fracture-dislocation can occur with comparatively less force.

Symptoms

The symptoms of a fracture-dislocation are typically severe and easy to recognise. Common signs include:

Intense pain at the affected joint and surrounding bone
Visible deformity of the joint or limb
Swelling and bruising (haematoma) around the injury site
Severely restricted or complete loss of joint movement
Numbness or tingling if nerves are involved
In severe cases: signs of vascular injury such as pallor or absent pulse

Diagnosis

Diagnosis of a fracture-dislocation involves a combination of physical examination and imaging studies:

Physical examination: Assessment of deformity, swelling, pain, and range of motion
X-ray: The standard first-line imaging tool to identify the fracture and joint malalignment
Computed Tomography (CT): Provides detailed views of complex fracture patterns and joint involvement
Magnetic Resonance Imaging (MRI): Used to evaluate soft tissue damage including ligaments, tendons, and cartilage
Neurovascular assessment: Essential to rule out associated nerve or blood vessel injuries

Treatment

Treatment depends on the affected joint, the severity of the injury, and the overall health of the patient. Two main approaches are available:

Conservative (Non-Surgical) Treatment

In less severe cases, non-operative management may be appropriate and includes:

Reduction: Manual realignment of the dislocated joint, usually performed under sedation or anaesthesia
Immobilisation: Splinting, casting, or use of an orthosis for several weeks
Physiotherapy: Targeted exercises to restore joint function and strength

Surgical Treatment

Complex or unstable injuries often require surgical intervention:

Open Reduction and Internal Fixation (ORIF): Surgical realignment and stabilisation of the bone using screws, plates, or nails
Ligament and capsule reconstruction: Repair of damaged soft tissue structures
Joint replacement (arthroplasty): Indicated when the joint is severely destroyed, for example at the hip

Complications and Prognosis

Without appropriate treatment, fracture-dislocations can lead to serious long-term complications, including:

Chronic joint instability
Post-traumatic osteoarthritis (joint degeneration following injury)
Avascular necrosis (bone death due to impaired blood supply)
Nerve damage with permanent numbness or weakness
Reduced range of motion and joint stiffness (contractures)

With timely and appropriate treatment followed by consistent rehabilitation, the prognosis for many patients is favourable. However, full recovery of joint function depends on the severity of the initial injury and individual healing response.

References

Buckley, R.E., Moran, C.G., Apivatthakakul, T. (eds.) - AO Principles of Fracture Management, 3rd edition, Thieme, 2017.
Rockwood, C.A., Green, D.P. (eds.) - Rockwood and Green's Fractures in Adults, 8th edition, Lippincott Williams and Wilkins, 2015.
Court-Brown, C.M., Heckman, J.D., McQueen, M.M. et al. - Rockwood and Green's Fractures in Adults, Wolters Kluwer Health, 2015.

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