Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Chapter 14: Dislocations

A joint is a complex assembly of bones, ligaments, cartilage, tendon, muscle, and synovial fluid. These structures can be injured in a wide variety of combinations and levels of severity. A disloca- tion occurs when enough force is applied to the bone to stretch or tear the restraining ligaments and allow the joint to come apart. The process of restoring a joint to its normal anatomical position is called reduction.

gruesome and painful medical emergency into a minor logistical dilemma. In cases where the deformity is the result of a direct impact, such as a fall while climbing or skiing into a tree, a dislocation is more likely to be complicated by fractured bone and cartilage.

Dislocations

General Principles

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Mechanism: • Indirect – leverage – torque • Direct – impact – crush

Dislocations

General Principles

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Joint Structure: bone, cartilage, tendon, muscle, ligament, fluid Function: support, mobility Problem: disability pain ischemia

S/sx: • Pain • No active ROM • Deformity • Distal CSM often impaired

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©2018WMA

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Reducing a dislocation under these circumstances involves more risk. Splinting in place and urgent evacuation is best when definitive care can be accessed quickly.

“Early reduction of a simple dislocation is a low risk treatment for a high risk problem.”

©2018WMA

There are three simple dislocations that are easy and safe to reduce in the field: the shoulder, patella (kneecap), and digits (fingers and toes). The Wilderness Protocol for joint reduction is for use in situations wherein the mechanism involves low-energy and indirect force. With proper technique, the medical officer can transform a