FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 143

Dislocations should be reduced. The risk of causing additional damage is quite small,
and any fractures of the joint surface are better aligned after reduction. Furthermore, dis-
locations should be reduced as quickly as possible. The muscles surrounding a dislocated
joint go into spasm quickly. The chances for successful correction of the dislocation de-
crease and the risk of further injury increases with the passage of time after injury.
Other advantages of early reduction of a dislocation are these:
Pain relief is often dramatic.
The risk of circulatory or neural damage is reduced.
Immobilization of the joint is easier.
Transportation of the injured person is easier.
Pain, pallor or cyanosis, swelling, numbness, or the absence of pulses beyond the dis-
location are indicative of obstruction of the blood supply. Entrapment or compression of
arteries isparticularly likely tooccur with dislocations ofthe elbow orknee. Prompt action
may be required to save the limb from gangrene.
The individual performing the reduction should use other members of the party if they
canhelpandmustensurethattheinjuredpersonunderstandsandagreeswithwhatisbeing
attempted and the technique to be used. Strong analgesics such as intramuscular or intra-
venous morphine are helpful; medications such as diazepam (Valium®) promote relaxa-
tionofthemusclesandtheinjuredindividual.Tractionmustbegentleandsteady;forceful,
jerking maneuvers must be avoided.
Afteranydislocation isreduced,theextremity shouldbesplintedinthesamemanneras
for a fracture. It may need to be immobilized for two to three weeks—sometimes longer.
Fingers
Dislocations of the fingers, which occur most commonly at the second joint, are usually
obvious and may be corrected quite easily immediately after the injury. Reduction is best
accomplished by holding the digit in a moderately flexed position and applying traction
while pushing the end of the dislocated bone back into place ( Fig. 11-7 ) .
Dislocations at the base of the index finger and at the base of the thumb may not be
reducible. With such injuries, surrounding ligaments and tendons often entrap the end of
the bone, and surgery is required for reduction. An initial effort to reduce such dislocations
should be made, but if unsuccessful the hand should be splinted in the position of function
and the person evacuated.
After reduction, an injured finger can be splinted effectively by taping it to an adjacent
uninjured finger.