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.