Wilderness and Rescue Medicine 8th Edition

Section IV: Trauma 109

Chapter 14 Review: Dislocations

• Dislocation is complete disruption of joint structure. It involves stretched or torn ligaments and can involve bruised or fractured cartilage and bone. • A dislocation is diagnosed by a positive mechanism of injury, gross deformity, and complete loss of active range of motion. Pain is usually severe. Obvious impaired distal CSM is common. • Dislocations from indirect force of the shoulder, patella, and digits are generally simple and easy to reduce in the field. There are many techniques for shoulder reduction. Low-risk techniques for field use are slow and gentle and require patient cooperation and relaxation. Simple external rotation, the baseball position, and scapular manipulation are three examples. • A patella dislocation is reduced by sitting the patient and gently extending the knee. Manual reduc- tion may be necessary if the dislocation does not reduce by the time the knee is fully extended. • Digit dislocations are reduced by gentle Traction into Position. • If reduction is successful and CSM is intact, there is no emergency. Protection from further injury and non-emergent medical follow-up are the treatments. • A failed reduction is a high-risk problem and requires urgent evacuation. • Dislocations from direct force and dislocations of the ankle, elbow, and hip are high-risk injuries and are manipulated only to restore circulation or to reduce the risk and complexity of evacuation.

The patella in its normal position (left), and dislocated (right).