FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 144

Figure 11-7. Technique for reducing a finger dislocation
Elbow
Dislocations of the elbow are usually obvious, particularly when compared with the op-
posite side. Most dislocations are posterior, and the tip of the dislocated ulna is very appar-
ent. Movement of the joint is restricted.
Elbow dislocations may be difficult to reduce. The slightly flexed forearm should be
pulled downward while the upper arm is pulled upward by an assistant. A considerable
amountofforceisusuallyneeded.Asthejointseparates,anysidewaysdisplacementofthe
bones should be corrected first. The forearm may need to be rocked back and forth very
gently. If the joint is not fully reduced, gentle bending of the elbow may complete the cor-
rection. The ability to flex the elbow to ninety degrees or more is proof of reduction.
Immediately after the dislocation has been reduced, the pulse at the wrist should be
checked. If the pulse is absent but the color of the hand is normal and pain is diminished,
the absence is probably the result of arterial spasm for which nothing needs to be done. If
the pulse is absent, the hand is darkly colored orcyanotic, and pain is increasing, the artery
totheforearmmayhavebeenentrappedwhenthebonesoftheelbowslippedbackintopo-
sition. The joint should be slightly separated again with traction (not dislocated again) and
gently rocked back and forth to free the entrapped structures.
The arm and hand should be splinted with the elbow at a ninety-degree angle. Pulse
and sensation should be checked again after the splint is applied. The elbow must not be
wrapped circumferentially with tape or bandages because swelling does occur and, if con-
fined, would compress blood vessels and nerves. Fracture of the bones of the elbow com-