FRACTURES AND RELATED INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 153

deformity and confirmed by the absence of pulses. The leg should be splinted as securely
as possible with precautions not to interfere with circulation. Dislocated knees are too un-
stable for walking.
If a knee dislocation has been reduced or instability suggests the knee has been dislo-
cated and has reduced spontaneously, the individual should be transported as quickly as
possible to a hospital where injury to the large vessels can be assessed. Even if the circula-
tion seems normal, damage to the blood vessels may have occurred and must be diagnosed
and repaired before irreversible ischemic damage to the lower leg occurs.
Kneecap
Dislocations of the kneecap (patella) frequently are recurrent, much like shoulder dis-
locations. The kneecap is usually displaced to the outside, and the knee is held in a flexed
position for comfort. Comparison with the opposite knee typically makes the abnormality
obvious.
To reduce the dislocation, the leg should be gently straightened while the kneecap is
pushed back into place. Straightening alone may be adequate. Extending the knee relaxes
the thigh (quadriceps) muscle, allowing the patella to reduce easily. The person is usually
able to walk with a splint. SAM Splints® folded double and placed medially and laterally
work well.
Ankle
Dislocated ankles are usually associated with fractures of the adjacent bones. They
should be reduced without delay and treated in the manner described for fractures. Redu-
cing (realigning) displaced fractures improves the circulation and facilitates splinting.
Jaw
An individual can become so completely relaxed while asleep that the jaw falls down-
ward and slips out of its socket. Usually such complete relaxation follows the use of sleep-
ing pills or overindulgence in alcohol. The jaw also can be dislocated by trauma or during
vomiting. People whose jaws have been dislocated are unable to close their mouth. In a re-
mote situation, the resulting inability to swallow could lead to serious difficulties.
Dislocations of the jaw can be safely reduced, usually rather easily ( Fig. 11-16 ). Both
thumbsshouldbeinsertedoverthemolarsofthelowerjawandpresseddirectlydownward.
Considerable force is required to overcome the spasm in the jaw muscles, which are quite
strong, but the jaw should slip back into place without too much difficulty. (The thumbs
should be padded to prevent bites as the jaw pops back into its socket.) After reduction,
persistent pain in the joint, which is located just in front of the ear, may be indicative of a
fracture, and a physician should be consulted. If dislocations recur, the individual can wear