FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 151

backpack with ten to fifteen pounds of weight is secured to the upper arm with duct tape
or an Ace® wrap. After fifteen to twenty minutes, the constant pull by the weight tires the
muscles surrounding the shoulder, causing them to relax enough for the humerus to slip
back into its socket. If the dislocation is not corrected within an hour, traction should be
discontinued, the arm splinted as well as possible, and the person evacuated ( Fig. 11-13 ) .
Following reduction of a shoulder dislocation, the arm should be immobilized for at
leasttwoweeks,preferablythree,withtwoslings,onesupportingtheforearmandhandand
the other holding the upper arm against the body. A recurrent dislocation of the shoulder
maynotrequiresuchlongimmobilization.Theultimatetreatmentofrepeatedshoulderdis-
locations is surgical repair ofthe lax ligaments that allow the dislocation, which may occur
with disabling frequency after insignificant trauma until reparative surgery is performed.
Dislocated shoulders sometimes cannot be reduced, and the discomfort makes rapid
evacuation necessary. When the shoulder is dislocated, the arm is held in an awkward pos-
ition that makes splinting difficult. Successful techniques use a strap or bandage to anchor
the hand on top of the head. Sometimes the hand is held close to this position spontan-
eously, but the muscles would soon tire, producing increased pain in the muscles and in
the shoulder. On ski slopes, effective splinting has been achieved with a rolled-up blanket
secured in a figure-eight position like the splint for a fractured clavicle but with the bulk of
the blanket in the armpit to support the upper arm. In more remote wilderness settings, a
similar splint would have to be devised.
Hip
Most hip dislocations are posterior and result from falls with the hip flexed. The force
of impact transmitted longitudinally through the knee and femur drives the femoral head
backward out of its socket. Strong forces are required to produce such injuries. Impact of
the knees with the dashboard in an automobile accident is a common cause. Anterior hip
dislocations are most commonly produced by falls in which the person lands directly on
the outer aspect of the hip and are encountered most commonly in children.
With a posterior dislocation, the hip is partially flexed and the leg is internally rotated,
so the knee is pulled upward and inward over the opposite leg; with an anterior dislocation
the hip is externally rotated with the knee turned outward and away from the body ( Fig.
11-14 ) . The key diagnostic clue with both types of dislocation is that returning the leg to a
normal position for splinting or transportation in a stretcher is impossible. The position of
theleghelpsdifferentiatedislocationsfromfracturesofthehiporthigh,withwhichtheleg
would lie flat. Reducing a dislocated hip ( Fig. 11-15 ) is difficult and painful, but is worth
attempting because reduction relieves pain, improves circulation to the femoral head, and
greatly facilitates placing the person in a basket stretcher for evacuation.