Wilderness and Rescue Medicine 8th Edition

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Section IV: Trauma

Risk Versus Beneft Dislocation reduction is a medical procedure usually reserved to licensed practitioners. Some emergency physicians even defer the procedure to orthopedic surgeons. That luxury does not often exist in the remote setting. Fortunately, reduction as described here is a low-risk procedure for a high-risk problem.

General Principles

“Sometimes, a dislocation is not so obvious without being able to see an x-ray. However, the complete loss of mobility of the joint is diagnostic.”

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After manipulation, test passive range of motion to be sure that reduction was successful. The joint will likely be a little swollen and sore with reduced active range of motion. Splint the joint in the mid- range, or by padding and taping the finger to the one adjacent (buddy taping). Remember to check CSM before and after reduction. Pain should improve with your treatment. Medical follow-up should occur within a week, if possible. Difficult Dislocations In the backcountry, any dislocation that resists your efforts at reduction can become a serious problem. Pain may be severe, and the potential for tissue damage due to ischemia increases with time. If CSM is significantly impaired and cannot be restored by traction and repositioning, imme- diate evacuation to medical care is warranted. Hip dislocations are difficult to distinguish from hip or pelvis fractures in the field. Pulling on a hip or pelvic fracture could lead to increased deformity and bleeding. Even if the diagnosis of dislocation is clear, significant analgesia and seda- tion are required for a successful reduction. Elbow dislocations are notoriously painful to reduce and there is a high incidence of long term complications. Like dislocations of the hip, pain medication and sedation are required. Manipulation of either in the field should be performed only to restore distal circulation in an ischemic limb.

Without the X-ray, it would be difficult to distin- guish a hip dislocation from this intertrochanteric fracture of the femur. The leg of this patient was shortened and rotated.

General Principles

Elbow Dislocation x-ray inset

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Although most medical control physicians are more comfortable with time and distance criteria for field reduction, for example two hours from definitive care for a dislocated shoulder, there is