Wilderness and Rescue Medicine 8th Edition

Wilderness and Rescue Medicine 106

Treatment of Digit Dislocation Digits usually dislocate at the proximal and distal interphalangeal joints (PIP and DIP). Reduction is relatively easy and should be performed in the field. Dislocations of the metacarpal-phalangeal joints (MCP), where the fingers join the hand, can be more difficult. Sometimes the base of the pha- lanx pokes through the joint capsule and becomes trapped there, preventing field reduction. If sev- eral attempts fail, splinting and evacuation for surgical reduction are indicated.

Patella Dislocation

General Principles

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Reduction: • Have the patient sit up and lean forward • Slowly straighten the knee, manually shift the patella medially when leg is straight • Usually there is no impairment of distal CSM

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Ideally, a reduced patella dislocation should be splinted as an unstable injury and the patient car- ried out. In more common and less than ideal situ- ations the knee could be wrapped or braced, and the patient walked out if pain and terrain permits. Taping the patella to prevent lateral displacement is often effective. It is important to avoid repeat- ing the mechanism of injury. If CSM is intact there is no emergency, but medical follow-up is important.

Digit Dislocation

General Principles

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Reduction: • TIP to normal anatomy • Check ROM and distal CSM Long-Term care: • RICE and splint or buddy tape to next digit • Medical follow-up, non-emergent if CSM is OK

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Patella Post Reduction

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General Principles

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Reduction will be easiest right after the injury has occurred, before swelling and pain inhibit it. Grasp the end of the dislocated finger with one hand, and the rest of the finger in the other. Slowly but firmly pull the end of the finger in the direc- tion it is pointing and then, while maintaining traction, swing it back into normal position. You will probably need to wrap the end of your patient’s finger in gauze or a bandanna to help keep your grip. Some crepitus will be felt during manipulation.

Long-Term Care: • Ice, NSAIDs. Swelling and pain are anticipated problems • Splint or tape to limit ROM and keep patella in mid-line • Carry-out evacuation is ideal, but walk-out is OK if patella is stabilized “As long as pain and swelling can be controlled there is no emergency, but medical follow-up is important.”

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Dislocations of Finger and Toes Joints in the digits usually dislocate due to an indi- rect force that levers the bone ends apart. Active range of motion is impossible, and there is often some degree of CSM impairment. These dislo- cations often have an associated small avulsion fracture that does not inhibit treatment. Like all dislocations, ischemia to infarction is an existing or anticipated problem.

Digit Dislocation Treatment

General Principles

“Slowly but firmly pull the end of the finger in the direction it is pointing and then, while maintaining traction, swing it back into normal position.”

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