3-66
upper leg or forced hyper- without ligamentous and vascular assessment and
extension of knee. Exam of capsular disruptions; gentle reduction with longi-
a knee that is reduced post inability to straighten leg; tudinal traction. Stabilize
injury but really swollen and injury to peroneal nerve with long leg splint and fre-
“floppy” probably represents and popliteal artery are quent vascular (q15min)
a dislocation that has spon- common re-checks MEDEVAC
taneously reduced and ASAP! LIMB
should be treated as such! THREATENING INJURY!
Subtalar Joint: Medial Most common type. AKA Swelling, tenderness, and Flex the knee and have an
“basketball foot” due to medial displacement of assistant hold the thigh.
frequency of injury when one the foot in plantar flexion Apply longitudinal traction
player lands on another’s and gently evert, abduct
foot and inverts it. and dorsiflex foot. Splint
Dislocation can be once reduced; may require
associated with osseous or open reduction
osteochondral fractures
Subtalar Joint: Lateral Rare Similar to above but with Flex the knee and have an
lateral displacement of the assistant hold the thigh.
abducted and plantar Apply longitudinal traction
flexed foot and gently adduct and
dorsiflex foot. Splint once
reduced; may require open
reduction
TECHNIQUES
Anterior and Posterior Shoulder Dislocations:
- Assessment: Examine the affected joint and determine the sensation of over the deltoid muscle to rule out
injury to the axillary nerve. Also confirm the sensation, circulation, and motor function of the forearm and
wrist. Repeat these evaluations post-reduction. - Differential Diagnosis: Fractures as above, combined fracture/dislocation; muscular contusion; brachial
plexopathy; acromioclavicular separation - Diagnostic Tests: X-ray if available to confirm dislocation and rule out fractures of the humerus, clavicle,
and scapula. (True AP scapula; scapular lateral; and an axillary view.) - Procedures:
a. Many dislocations can be reduced without anesthesia, especially if the reduction is performed immedi-
ately after the dislocation occurs. However, if anesthesia is required, develop a sterile injection site,
and with a 1-1/2 in 20 Ga. needle, inject 20 ml of 1% lidocaine inferior and lateral to the acromion
process in the depression left by the displaced humeral head. Allow the local 10 min. to set up and
the patient to begin to relax.
b. Reduction maneuvers: Reassure the patient that you will not make sudden, unexpected moves, and
that you will stop momentarily if pain occurs. Halt all efforts at reduction if there is marked pain, or
crepitus noted that would suggest a concomitant fracture.
- Self-Reduction: Instruct the patient to sit on the ground with his back to a tree, wall, etc. and
flex the knee to the body on the same side as the injured shoulder. Have the patient grasp the
knee with both hands (fingers interlaced) and then slowly extend the leg. The slow extension of
the leg may provide all the traction required to reinsert the humeral head back into the glenoid.
This technique works especially well if instituted early with acute injuries, or on recurrent dislocators
and requires minimal assistance. However, for the first time dislocator, assistance may be required
as detailed below. - Stimson: Place patient on table in prone position with affected arm hanging off the table. Hang
about 10-15 lbs from the wrist (holding weights diminishes capacity to relax shoulder) to provide