Wilderness and Rescue Medicine 8th Edition

Chapter 14: Dislocations

A joint is a complex assembly of bones, ligaments, cartilage, tendon, muscle, and synovial fluid.These structures can be injured in a wide variety of combi- nations and levels of severity. A dislocation occurs when enough force is applied to the bone to stretch or tear the restraining ligaments and allow the joint to come apart. The process of restoring a joint to its normal anatomical position is called reduction.

In cases where the deformity is the result of a direct impact, such as a fall while climbing or skiing into a tree, a dislocation is more likely to be complicated by fractured bone and cartilage. Reducing a dislocation under these circumstances involves more risk. Splinting in place and urgent evacuation is best when definitive care can be accessed quickly.

Dislocations

Dislocations

General Principles

General Principles

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Mechanism: • Indirect - leverage - torque • Direct - i mpact - crush S/ S x: • Pain • No active ROM • Deformity • Distal CSM often impaired

Joint Structure: • B one, cartilage, tendon, muscle, ligament, fluid Function: • S upport, mobility Problem: • D isability • P ain • I schemia

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“Early reduction of a simple dislocation is a low - risk treatment for a high - risk problem.”

© 2018 WMA

© 2018 WMA

There are three simple dislocations that are easy and safe to reduce in the field: the shoulder, patella (kneecap), and digits (fingers and toes).The Wilderness Protocol for joint reduction is for use in situations wherein the mechanism involves low- energy and indirect force. With proper technique, the medical officer can transform a gruesome and painful medical emergency into a minor logistical dilemma.