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Circulation and neurologic function to the hand are usually not compromised, but if they
are, attempt reduction with gentle in-line traction.
D. Fingers: Obvious deformity and limited function are the main diagnostic factors.
Reduction of dislocations of middle and distal interphalangeal joints is accomplished by
maintaining the digit in partial flexion and pushing the dislocated base of the phalanx
back in place while traction is applied to the partially flexed digit.
There are two hand dislocations in which reduction is difficult, if not impossible,
by closed means: dislocation of the metacarpophalangeal joint of the index finger and the
metacarpophalangeal joint of the thumb. The thumb is sometimes reducible closed, but
the index metacarpal rarely is. Make one attempt, then immobilize the joint in a
functional position. Do not persist with multiple attempts.
E. Hip: The majority of dislocations are posterior. The hip will be moderately flexed,
internally rotated and adducted. Any attempt to extend the hip for splinting or easier
transport will be resisted by the patient and is mechanically nearly impossible to
accomplish. Anterior dislocation of the hip results in a posture of extension, external
rotation and abduction. Again, attempting to extend the hip to a neutral position is very
difficult, if not impossible, and is resisted by the patient.
If skill and equipment are available, the use of intramuscular or intravenous
muscle relaxants or analgesics greatly facilitate any reduction. This reduction requires
two people, ideally, with one applying counter-traction to the pelvis with the patient lying
in a supine position on the ground. In the case of a posterior hip dislocation, the involved
hip and knee are flexed to 90 degrees with the rescuer straddling the patient and applying
traction in an upward direction. If only one person is available to attempt the reduction,
the victim can be placed prone over a log, rock, or bench, and the traction applied
downward with hip and knee flexed 90 degrees. Once reduced, the injured hip must be
immobilized to the uninvolved extremity and the patient transported in a supine position.
F. Patella: Most often, the patella is laterally displaced with the knee held in flexion for
comfort. Such an injury is often recurrent and caused by a pivoting type of injury with a
partially flexed knee. The patella is not movable and is obviously out of place.
Flex the hip to relax the quadriceps, then apply gentle traction to extend the knee.
In most cases, the patella will slip back into its groove. Applying direct, gentle pressure
to the patella from the lateral aspect may be necessary to attain reduction. Immobilize the
extremity with a cylinder splint. With the knee extended and immobilized, the patient
may be able to walk well enough for self-evacuation.
G. Knee: Major ligamentous disruption is the rule in dislocations of the knee. The knee
may not be dislocated at the time of exam, but gross instability is the major clue, and
vascular impairment is an important risk. Check pulses and motor function in ankle and
foot.
Gentle realignment of the joint benefits damaged neurovascular structures. Splint
securely, without compromising circulation to the foot. The patient must be carried out.
