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May 10, 2019

The national athletic trainers’ association (in the USA) recently released a position statement on the management of dislocated joints as they pertain to the limbs.

The main talking point in this article was whether or not joints should be put back in place (or reduced on the spot) and guidelines for making decisions regarding patient care if a dislocation occurs.

Essentially the article summarizes that under the direction of a physician the majority of joints in the upper and lower limb can be safely be reduced onsite. This included the femoroacetablular which is frankly surprising to me. While the article does discuss increased safety precautions surrounding the hip, I am not sure I’ve met anyone that would feel comfortable reducing a hip onsite without X-rays. Especially due to the increased risk of neurovascular injury as a result of the procedure.

One clear message from the association was that outside of kneecaps, all other dislocations in children should be reduced only after X-rays are taken. This is due to the fact the children are at increased risk of fractures as growth plates have yet to fuse

Lastly, remember that the ability to reduce a joint is largely a protected act. The article summarizes the legal implications of performing a reduction on even the seemingly most innocuous joints if the act is outside of your scope of practice.

Safety is the most important part of these procedures to avoid long term complications from onsite reductions gone wrong. When in doubt extra precautions should be taken to ensure patient safety.

Have you ever had a shoulder, wrist or hand put back in place following an injury? Did you have any complications following the procedure?

SOURCES

Rizzo et al. (2018) National Athletic Trainers’ Association Position Statement: Immediate Management of Appendicular Joint Dislocations. Journal of Athletic Training, 53, 12. doi:10.4085/1062-6050-97-12


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